Postoperative handover: development and validation of a checklist for paediatric patients

Background: Postoperative handover represents a high-risk phase in paediatric surgical care, where inconsistent communication and informational gaps may compromise continuity and patient safety. Despite the recognised importance of structured handover tools, there is a lack of validated, context-specific instruments tailored to the postoperative transfer of paediatric surgical patients. Objective: To develop and validate a structured postoperative nursing handover checklist for paediatric surgical care, integrating qualitative insights from healthcare professionals with quantitative evaluation of content validity and inter-rater reliability. Methods: An exploratory sequential mixed-methods design was conducted at the Paediatric Surgery Unit and Paediatric Operating Block of the University Hospital of Padua. In the qualitative phase, two multidisciplinary focus groups (n=15) involving paediatric surgeons, anaesthesiologists, operating room nurses, and ward or ICU nurses were analysed using inductive thematic analysis supported by ATLAS.ti. In the quantitative phase, 13 clinical experts assessed content validity (I-CVI, S-CVI/Ave, S-CVI/UA, modified Kappa). Inter-rater reliability was tested in 110 postoperative procedures, with two independent nurses completing the checklist simultaneously. Cohen’s κ and absolute agreement were calculated for dichotomous items and narrative fields. Results: Seven themes—informational discontinuity, differences across units, tools and methodologies, traceability and documentation, debriefing, patient safety, and organisation and responsibility—were identified and used to construct a preliminary 21-item checklist. Content validity was excellent, with S-CVI/Ave values ranging from 0.912 to 0.941 across relevance, clarity, completeness, and necessity. Only minimal item refinement was required. Inter-rater reliability was very high, with median κ=0.96 for dichotomous items and κ=0.93 for qualitative notes; agreement consistently exceeded 98%. Several items showed non-computable κ due to zero variance but achieved 100% observed agreement. The final checklist demonstrated clarity, usability, and applicability in real-world perioperative settings. Conclusions: The study produced one of the first context-specific validated nursing checklists focusing on postoperative paediatric surgical handover within an Italian tertiary centre. The tool shows strong content validity, excellent inter-rater reliability, and clear potential to standardise communication, enhance traceability, and reduce omissions during care transitions. Future research should evaluate its impact on clinical outcomes and explore integration into digital documentation systems.