When More May Be Better: Reconceptualizing Clinical Handoffs in Modern Medicine

Background Clinical handoffs are traditionally viewed as an area of vulnerability in patient safety, linked to miscommunication, adverse events, and prolonged hospitalizations. However, accreditation bodies have mandated standardized handoff training and processes, thereby embedding these practices into healthcare systems. In the neonatal intensive care unit (NICU), where complex and prolonged hospitalizations are common, handoffs may represent opportunities to enhance care. This study evaluated the relationship between the number of handoffs and length of stay (LOS) in infants with gastroschisis. Methods A retrospective cohort study was conducted of neonates with gastroschisis admitted to a level IV NICU between 2012 and 2020. Infants transferred before discharge or with incomplete records were excluded. Demographic, clinical, and surgical data were abstracted, including the presence of intestinal complications and closure type. Handoffs were quantified by the number of unique neonatologists and pediatric surgeons involved in care. Descriptive statistics and correlation analyses were performed, with multivariable models adjusting for severity and surgical covariates. Results Of 127 identified infants, 87 met the inclusion criteria. The median gestational age was 36 weeks, and 58% underwent primary closure. The median number of handoffs was 21, and the median length of stay (LOS) was 31 days. More handoffs per day were associated with shorter length of stay (r = -0.28, p = 0.0069). This association persisted after adjustment for confounders (β = -57.1, p = .034). Conclusions In this retrospective study, greater numbers of handoffs were associated with shorter hospitalizations in neonates with gastroschisis. Handoffs may provide opportunities for critical thinking, adaptive decision-making, and collaborative recognition of complications within complex sociotechnical systems. These findings highlight the need to reframe handoffs not solely as risks but as potential tools to optimize patient outcomes.