Understanding nursing handoff errors in clinical practice: trends and contributing factors based on a systematic review and meta-analysis

BACKGROUND: Nursing handoff is a critical process in which essential patient and treatment-related information, as well as responsibilities, are exchanged to ensure quality of care and continuity of treatment. Errors during this process may lead to adverse clinical outcomes and compromise patient safety. This study aimed to systematically review the overall trends of and factors contributing to nursing handoff errors in clinical settings to enhance nurses’ awareness and understanding. METHODS: Following a study protocol pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024610621), a systematic review was conducted, including a comprehensive search of Public MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus. A systematic review and meta-analysis were performed based on selected studies, adhering to the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Twelve studies were included in the systematic review, six of which were eligible for meta-analysis. The most commonly identified type of nursing handoff error was information omission. Contributing factors fell into four categories: handoff process complexity, environmental, organizational, and individual factors. The pooled proportion of nursing handoff errors derived from the meta-analysis of six studies was approximately 88% (pooled proportion = 0.88, 95% CI = 0.72 ~ 0.99; I² = 98%), indicating substantial variability across studies. This estimate represents the overall occurrence of reported handoff error types across the included studies. CONCLUSIONS: Reducing nursing handoff errors requires a multidimensional approach encompassing the handoff communication process, physical environment, organizational systems, and individual nurse competencies. This study underscores the importance of targeting key error types and contributing factors to develop integrated strategies such as structured communication tools, standardized protocols, and competency-based training that collectively enhance handoff quality and patient safety. CLINICAL TRIAL NUMBER: Not applicable.