Safety-Critical Handoff Analysis

Model and evidence

Safety handoffs combine structured content, explicit action lists, contingency planning, situation awareness, synthesis/read-back, training, and implementation fidelity. I-PASS reduced a composite adverse-event outcome in 3,744 handoffs [EV-SAFETY-2026-19D5], but systematic review finds heterogeneous, often low-certainty evidence and difficult fidelity [EV-SAFETY-2026-7EA2].

Counterevidence and methods

Bundles obscure active ingredients; checklist compliance can displace judgment; domain stakes and team structures differ. Reusable methods include adverse-event rates, omission analysis, read-back accuracy, simulation, fidelity audit, near-miss review, and risk-weighted outcomes.

Coverage, gap, and challenged assumptions

Human factors already explains structured handoff plus closed-loop confirmation. It rejects “template completion equals safety.” Software transfer requires different hazards, time scales, and reversibility.

Discriminating experiment

Compare document-only, document-plus-read-back, and usual care on seeded high-risk software scenarios. If closed-loop confirmation drives benefit, the artifact-only theory is wrong.

Confidence and limits

High clinical evidence relevance; Low-to-Medium cross-domain transfer.

Ten future questions

1. What is software's analogue of an adverse handoff event?
2. Which I-PASS components transfer?
3. Does read-back detect incorrect assumptions?
4. How should handoffs scale with hazard severity?
5. When does checklist use suppress expertise?
6. Which fidelity measure predicts outcomes?
7. Can near misses be captured without blame?
8. How do asynchronous handoffs achieve closed loop?
9. What is the minimum safe contingency plan?
10. Does the proposed profile outperform adapted human-factors practice?

Completion assessment

Bounded map complete; software-domain trial remains debt.