Assessing Compliance, Completeness, And Contributing Factors of Postoperative Handover Practices in Post-Anesthesia Care Units in Rwanda: A Cross-Sectional Observational Study

Abstract Background Effective postoperative handover in the post-anesthesia care unit (PACU) is essential for patient safety and continuity of care. However, in many healthcare settings, particularly in resource-constrained environments, this process remains incomplete and unstructured. This study assessed postoperative handover practices among theatre teams at two district hospitals in Kigali, Rwanda, focusing on compliance with the SBAR (Situation, Background, Assessment, Recommendation) framework, completeness of information transfer, and contributing factors. Methods A cross-sectional observational study was conducted at Kibagabaga Level II Teaching Hospital and Kacyiru District Hospital between February and May 2025. A total of 130 postoperative handovers were directly observed using a structured checklist adapted from the Postoperative Handover Assessment Tool (PoHAT) and based on the SBAR protocol. Data were analyzed using SPSS version 27.0 and Microsoft Excel. Descriptive statistics, chi-square tests, and Pearson correlation analysis were employed to assess handover completeness and identify associated factors. Statistical significance was set at p < 0.05. Results Anesthetists initiated 72.3% of handovers; midwives (55.4%) and nurses (44.6%) were primary recipients. Most handovers occurred within 10 minutes of patient arrival (73.1%) and lasted less than 5 minutes (77.7%). The Situation component was complete in 68.5% of handovers; ASA classification was reported in only 33.8%. In the Background domain, type of anesthesia (92.3%) and surgical procedure (90.0%) were frequently communicated, while allergy history (46.2%) and intraoperative events (56.2%) were often omitted. Airway status (20.0%) and intraoperative findings (19.2%) were the least reported Assessment elements. Discharge criteria were communicated in only 13.8% of handovers. The absence of a structured handover protocol was universal (100%), and multitasking was observed in 67.7% of handovers. Multitasking showed a significant negative correlation with SBAR completeness (r = -0.405, p < 0.001) and a significant association with procedural failures (chi-square = 16.277, p < 0.001). Conclusions Critical information was frequently omitted during postoperative handovers at two district hospitals in Rwanda. The complete absence of structured protocols and high prevalence of multitasking significantly compromised handover quality. Implementing standardized SBAR-based handover protocols, reducing multitasking, and targeted training are essential to improve handover completeness and patient safety.