{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:29:57Z","timestamp":1764883797741,"version":"3.46.0"},"reference-count":32,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["1K12TR004908-01","1UM1TR004906-01"],"award-info":[{"award-number":["1K12TR004908-01","1UM1TR004906-01"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,3]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intraoperative anaesthesia handoffs represent a risk point in the care of surgical patients. Although often necessary to prevent fatigue, improve vigilance and optimise operational efficiency, critical information can be lost, potentially leading to postoperative complications. Structured handoffs can increase the transfer of knowledge during intraoperative anaesthesia handoffs, improving their quality. We therefore propose to test the primary hypothesis that a semi-structured intraoperative anaesthesia handoff cognitive aid reduces the number of serious 30-day complications in surgical patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will enrol adults having non-cardiac surgery who are scheduled to have an intraoperative anaesthesia handoff for operational reasons. We plan a cluster randomised trial (enrolling over 18 months, anticipated sample size approximately 4500 patients) that will compare the Epic Electronic Health Record intraoperative anaesthesia handoff cognitive aid to routine handoffs. Our primary outcome will be the number of serious postoperative complications within 30 days. Our secondary outcomes will be: (1) the number of minor complications; and (2) the duration of postoperative hospitalisation. Bayesian analysis with generalised linear multilevel modelling will be used to estimate the effect of structured handoffs on the primary and secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the local institutional review board with a waiver of informed consent. Results will be disseminated in the medical literature with de-identified data available on request.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06533111\">NCT06533111<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110401","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T13:48:36Z","timestamp":1762264116000},"page":"e110401","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the impact of a semi-structured intraoperative anaesthesia handoff cognitive aid on surgical patient outcomes: study protocol for a cluster randomised trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06533111","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06533111","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4747-461X","authenticated-orcid":false,"given":"Aubrey","family":"Samost-Williams","sequence":"first","affiliation":[{"name":"Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA"},{"name":"Center for Outcomes Research, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles E","family":"Green","sequence":"additional","affiliation":[{"name":"Psychiatry and Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3567-8159","authenticated-orcid":false,"given":"Lillian S","family":"Kao","sequence":"additional","affiliation":[{"name":"Surgery, Center for Surgical Trials and Evidence-based Practice, The University of Texas Health Science Center, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srikanth","family":"Sridhar","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel I","family":"Sessler","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA"},{"name":"Center for Outcomes Research, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alparslan","family":"Turan","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA"},{"name":"Center for Outcomes Research, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric J","family":"Thomas","sequence":"additional","affiliation":[{"name":"Internal Medicine, The University of Texas Health Scince Center at Houston, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2025120413254762000_15.11.e110401.1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew316"},{"key":"2025120413254762000_15.11.e110401.2","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/ALN.0000000000001246","article-title":"Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes","volume":"125","author":"Terekhov","year":"2016","journal-title":"Anesthesiology"},{"key":"2025120413254762000_15.11.e110401.3","first-page":"396","article-title":"Intraoperative Handoffs Among Anesthesia Providers Increase the Incidence of Documentation Errors for Controlled Drugs","volume":"43","author":"Epstein","year":"2017","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"2025120413254762000_15.11.e110401.4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1053\/j.jvca.2014.05.018","article-title":"Impact of anesthetic handover on mortality and morbidity in cardiac surgery: a cohort study","volume":"29","author":"Hudson","year":"2015","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025120413254762000_15.11.e110401.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.20040"},{"key":"2025120413254762000_15.11.e110401.6","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004839"},{"key":"2025120413254762000_15.11.e110401.7","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000401"},{"key":"2025120413254762000_15.11.e110401.8","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1001\/jama.2022.9451","article-title":"Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults: The HandiCAP Randomized Clinical Trial","volume":"327","author":"Meersch","year":"2022","journal-title":"JAMA"},{"key":"2025120413254762000_15.11.e110401.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2020-012298"},{"key":"2025120413254762000_15.11.e110401.10","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/EJA.0000000000000636","article-title":"Training in intraoperative handover and display of a checklist improve communication during transfer of care: An interventional cohort study of anaesthesia residents and nurse anaesthetists","volume":"34","author":"Jullia","year":"2017","journal-title":"Eur J Anaesthesiol"},{"key":"2025120413254762000_15.11.e110401.11","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000506"},{"key":"2025120413254762000_15.11.e110401.12","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005367"},{"key":"2025120413254762000_15.11.e110401.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-003957"},{"key":"2025120413254762000_15.11.e110401.14","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00583"},{"key":"2025120413254762000_15.11.e110401.15","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2019.00158","article-title":"Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies","volume":"7","author":"Fernandez","year":"2019","journal-title":"Front Public Health"},{"key":"2025120413254762000_15.11.e110401.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.jcadva.2025.100099","article-title":"Implementation Mapping to Guide Adoption of a Semi-Structured Intraoperative Anesthesia Handoff Tool","volume":"2","author":"Samost-Williams","year":"2025","journal-title":"JCA Adv"},{"key":"2025120413254762000_15.11.e110401.17","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1055\/s-0041-1731714","article-title":"A Collaborative Partnership between the Multicenter Handoff Collaborative and an Electronic Health Record Vendor","volume":"12","author":"Hong Mershon","year":"2021","journal-title":"Appl Clin Inform"},{"key":"2025120413254762000_15.11.e110401.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1405556"},{"key":"2025120413254762000_15.11.e110401.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-021-01466-9","article-title":"Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review","volume":"21","author":"Black","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"2025120413254762000_15.11.e110401.20","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1213\/ANE.0000000000006751","article-title":"A Qualitative Study of the Work Systems and Culture Around End-of-Day Intraoperative Anesthesia Handoffs in a Tertiary Care Center","volume":"139","author":"Samost-Williams","year":"2024","journal-title":"Anesth Analg"},{"key":"2025120413254762000_15.11.e110401.21","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1213\/ANE.0000000000002286","article-title":"More Than a Tick Box: Medical Checklist Development, Design, and Use","volume":"126","author":"Burian","year":"2018","journal-title":"Anesth Analg"},{"key":"2025120413254762000_15.11.e110401.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.05.062"},{"key":"2025120413254762000_15.11.e110401.23","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1093\/clinchem\/hvad005","article-title":"High-sensitivity Troponin I Predicts Major Cardiovascular Events after Non-Cardiac Surgery: A Vascular Events in Non-Cardiac Surgery Patients Cohort Evaluation (VISION) Substudy","volume":"69","author":"Borges","year":"2023","journal-title":"Clin Chem"},{"key":"2025120413254762000_15.11.e110401.24","unstructured":"R Core Team . R: A langauge and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2023."},{"key":"2025120413254762000_15.11.e110401.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02039-0"},{"key":"2025120413254762000_15.11.e110401.26","doi-asserted-by":"crossref","unstructured":"Merkle EC , Fitzsimmons E , Uanhoro J , et al . Efficient Bayesian Structural Equation Modeling in Stan . J Stat Soft 2021;100. doi:10.18637\/jss.v100.i06","DOI":"10.18637\/jss.v100.i06"},{"key":"2025120413254762000_15.11.e110401.27","doi-asserted-by":"publisher","DOI":"10.1007\/s11222016-9696-4"},{"key":"2025120413254762000_15.11.e110401.28","doi-asserted-by":"publisher","DOI":"10.1007\/s11222-013-9416-2"},{"key":"2025120413254762000_15.11.e110401.29","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2019.4620","article-title":"Association of Preoperative Patient Frailty and Operative Stress With Postoperative Mortality","volume":"155","author":"Shinall","year":"2020","journal-title":"JAMA Surg"},{"key":"2025120413254762000_15.11.e110401.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.7020.1621"},{"key":"2025120413254762000_15.11.e110401.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2008.07.006"},{"key":"2025120413254762000_15.11.e110401.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2012.05.034"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:26:29Z","timestamp":1764883589000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,4]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-110401"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110401","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}