Review question

What strategies can improve physician-to-physician handover from acute care to rehabilitation?

Protocol and registration

The protocol was registered and published on Open Science Framework (Registration https://doi.org/10.17605/OSF.IO/Y6DRU).

Eligibility criteria

The selection of studies will be guided by specific inclusion and exclusion criteria to ensure the relevance and focus of this scoping review. All study designs written in English, both qualitative and quantitative studies, will be considered for inclusion. Although studies will initially be included during title and abstract screening stage if abstracts are written in English, they will be excluded if full-text studies are not available in English. All geographical areas will be considered. This broad approach allows for a comprehensive understanding of the strategies employed in physician-to-physician handovers.

The review will focus on studies that discuss physician-physician handovers for patients being transferred from acute care to rehabilitation settings. Studies involving patients of all ages in handovers will be eligible for inclusion. Acute care will be defined broadly to encompass a wide range of medical and surgical services typically involved in the initial management of patients prior to rehabilitation. Some examples of services include general internal medicine, surgery, cardiology, oncology, intensive care and emergency units. Freestanding rehabilitation hospitals, non-freestanding rehabilitation and skilled nursing facilities were considered as rehabilitation services. By including diverse post-acute care settings, the review aims to capture a wide range of handover practices and strategies.

For the purpose of this scoping review, “physician” will be defined as any individual holding a Doctor of Medicine (MD) degree or equivalent, including but not limited to physiatrists, hospitalists, residents or other medical doctors involved in patient care. Studies describing multi-disciplinary handover processes with other health professionals will also be included if a physician was either providing or receiving handover. Handovers within a rehabilitation hospital or handovers between nursing staff or other allied health professionals will be excluded.

Case reports, case series, commentaries, protocols, opinion pieces (editorials), or abstracts from conferences will be excluded.

Search strategy

A comprehensive search strategy was developed in consultation with a health sciences librarian experienced in systematic and scoping reviews. The search was conducted across the following electronic databases: MEDLINE(R) ALL (Ovid), Embase Classic + Embase (Ovid), APA PsycINFO (Ovid), Cohrane Central Register of Controlled Trials (Ovid), Emcare (Ovid), CINAHL Ultimate (EBSCO), Web of Science Core Collection (Clarivate). The initial search strategy was developed in MEDLINE(R) ALL and tested using a set of target articles provided by the team.

The search strategy included subject headings (e.g., MeSH) and text words for 4 search concepts: A) Inpatient rehab facilities, B) handoff/handover, and C) care transitions, and D) communication/information exchange. Our final search strategy is A AND (B OR (C AND D)) which translates to 1) Inpatient rehab facilities AND handoff/handover, and 2) Inpatient rehab facilities AND care transitions AND communication/information exchange.

“Acute care” as a separate search concept was not included in our search strategy to avoid unintentionally excluding relevant studies. Defining and capturing the full scope of acute care settings using database search terms is highly complex as “acute care” may encompass a wide range of medical and surgical specialties such as general medicine, surgery, cardiology, oncology, intensive care, and emergency services. Therefore, including “acute care” search terms could have inadvertently filtered out eligible studies describing transitions to rehabilitation. Instead, we focused the search on rehabilitation-related settings, which inherently implies a transition from an acute care environment. This approach aligns with the aim of the scoping review which is to examine physician-to-physician handovers occurring at the point of transfer from acute care to rehabilitation.

Some key search terms included: rehabilitation hospitals, inpatient rehabilitation, handoff, handover, signovers, etc. No limits were applied to the search strategy (e.g., publication date, language, etc.). The MEDLINE(R) ALL search strategy was later revised with recommendations from the PRESS (Peer Review of Electronic Search Strategies) by a medical librarian. We thank Emilia Main, MI (Toronto Rehab, University Health Network) for peer review of the submitted search strategy. The final Medline strategy was then translated to the other electronic databases. For the full search strategies, please refer to S1 Appendix. The databases were searched from inception to February 5, 2025, and will be updated prior to submission of the scoping review for publication if more than 6 months has elapsed since the last search date. Citation tracking will also be used as a supplementary search method. The reference lists of the included studies will be reviewed for additional studies that meet the inclusion and exclusion criteria. Web of Science will use used to generate a citation report for forward and backward citation tracking of included studies.

Study/Source of evidence selection

Following database searches, all identified studies will be uploaded to Covidence. Following a pilot test to ensure consistent application of inclusion criteria, each study will undergo title and abstract screening by two independent reviewers. Full-text articles that meet the inclusion criteria from title and abstract screening will be retrieved. A subsequent round of screening will be conducted independently by two reviewers on the full-text articles. Each round will be screened in duplicate. Screening agreement will be reached when there are two yes or two no votes in Covidence. If any conflicts arise, an additional screener will resolve the disagreement. The voting decisions will be blinded to the additional screener. A PRISMA-ScR flow diagram will visually present the entire study screening process. For the full PRISMA-ScR flow diagram, please refer to S2 Appendix.

Data extraction

The data extraction process will consist of a pilot stage followed by final extraction. They will be completed in duplicate by four extractors and discrepancies in data extraction will be resolved by an additional extractor. We will employ the Template for Intervention Description and Replication (TIDieR) template to ensure sufficient detail extraction regarding the interventions and any additional entities relevant to the concepts in this study [11]. Upon reasonable request, the CSV data will be made available. Data collection will be expected to be completed by Sept 1^st, 2025.

The extracted entities will include: study title, country of origin, year of publication, and study design (e.g., qualitative, quasi-experimental, randomized controlled trial). In accordance with the TIDieR framework, we will extract the rationale (describing the theory or goal of the intervention’s key elements), what was done to increase handover (e.g., department education session followed by policy implementation), materials used (e.g., “I-PASS” lanyards, EMR handover template), procedures (detailed description of intervention activities and processes), the profession of who provided the intervention (e.g., physician leader, manager), how the intervention was delivered (mode of delivery - face-to-face vs. videoconference, individual vs. group-based), when and how much the intervention was delivered (number of sessions, schedule, duration, intensity, or dose), any tailoring of the intervention (personalization, titration, or adaptation), and any modifications made during the study (what, why, when, and how). Intervention adherence, both planned and actual, will also be extracted, including assessment methods and strategies to improve fidelity. Additional extracted data will encompass: patient population characteristics, the acute care site characteristics (number of beds, type of service, academic vs. community), rehab site characteristics (number of beds, type of rehab, freestanding vs. non-freestanding rehab hospital or skilled nursing facility, academic vs. community), acute care and rehab provider characteristics (specialty, learners/staff/both), timeframe of handover (before or after admission and the specific timeframe), format of the handover (phone call, videoconference, email), and whether the study aimed to improve discharge summary completion (Yes/No…). Furthermore, we will extract the outcome type (qualitative, quantitative, or both), outcome measures (tools used to assess intervention effectiveness, e.g., % of handovers completed), outcome results, and any balancing measures (unintended consequences of the intervention).

Data analysis and presentation

The extracted data will be summarized both quantitively with descriptive statistics and qualitatively using content analysis. In the event of missing data, study authors will be contacted for clarification. The synthesis will be conducted in duplicate and involve two synthesists working independently to analyze and code the data manually. Any discrepancies will be reviewed by an additional synthesist. The synthesized data will be available upon reasonable request. Results are expected to be completed by Nov 1^st, 2025.