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Scholarly Commons > HCA Healthcare Journal > Vol. 7 > Iss. 5 (2026)

 

Keywords

clinical handoff; closed-loop communication; high-reliability organizations; patient safety; psychological safety; safety culture; situation awareness; surgical critical care; transitions of care; trauma

Disciplines

Surgery | Trauma

Abstract

Safety in trauma and surgical critical care is inseparable from the reliability of communication at transitions of care. Handoffs are recurrent, high-risk moments in which teams transfer not only information but responsibility, prioritization, uncertainty, and contingency planning; failures at these points propagate into omissions, delayed escalation, and preventable harm to patients and strain on the workforce. Structured handoff tools improve completeness and clarity but inconsistently change hard clinical endpoints, and tools alone do not create the culture of safety on which high-reliability organizations (HROs) depend. This narrative review synthesizes civilian handoff research, human-factors and HRO theory, situation-awareness, psychological safety, trauma video review, and military medical lessons-learned into a single implementable framework for safer trauma and surgical intensive care unit (SICU) transitions. We propose a 5-stage communication cycle: (1) teams Brief before transfer to establish roles, a shared mental model, and anticipate threats; (2) Handoff using a structured tool matched to the transition; (3) Backbrief so the receiver synthesizes high-risk items and ownership; (4) Threat Forecast to state explicitly what may deteriorate and what triggers escalation; and (5) Post-hoc Review to convert selected transitions into learning. The stages map onto HRO hallmarks and depend on psychological safety, deference to expertise, and the inclusion of nurses and other frontline staff whose voices and well-being are integral to safe transitions. Because rare clinical endpoints are difficult to attribute, we offer a layered measurement framework spanning process, team-behavior, documentation, clinical, and workforce-culture measures. Reframing the handoff from a single script into a repeatable, high-reliability communication cycle offers trauma and SICU teams a scalable, adaptable strategy for enhancing safer health care systems.

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