A total of 208 responses were received (n = 167 paper surveys, n = 41 web-based), representing a 52.3% response rate (total number of surveys received/total number of surveys distributed, n = 398). Of these, 96% (n = 200) were completed by patients. The remaining responses were completed on behalf of patients, including by parents and guardians (n = 5), carers (n = 1), family members (n = 1), or unspecified individuals (n = 1). The majority of participants were between 51 and 70 years old (40.4%, n = 84). Most patients (55.7%, n = 116) reported being cared for exclusively by surgical doctors during their admission, while 6.2% (n = 13) were unsure whether their primary team was medical or surgical. The median length of stay prior to survey completion was five days (1–98). Most patients (90.4%, n = 188) reported meeting 10 doctors or less during their stay; however, two reported seeing more than 20. The median rate of missing responses for each question was 3.8% (0–10.4%; Additional File 1) and data were assumed to be missing at random. Information to examine non-response error was unavailable. The final survey had a satisfactory Flesch Reading Ease Score (69.4) and Flesch-Kincaid Grade level (6.3) [27].

Patient and Public Involvement (PPI) results

Accessibility issues identified by patients during the pilot phase included text being too small for individuals with impaired vision, difficulties faced by those with reduced literacy requiring a data collector to read the questions aloud and record responses, and the need for parents or guardians to complete the survey on behalf of younger patients. Patients also suggested improvements for survey distribution methods to enhance accessibility and participation. The patient and public involvement partner on the study team identified and helped to rectify issues with question content, order, clarity, and readability.

Patient awareness of handover processes

Significantly more patients reported having prior knowledge of nursing handovers (73.1%) compared to doctors'handovers (63.9%; x2 = 14.53, p = 0.0002). Only 24.5% (n = 51) indicated that doctors explained the concept of ‘handover’ to them during their stay. Of the remaining patients, 57.1% (n = 84) would have liked to receive this explanation. The majority of patients (72.6%, n = 151) were aware that junior doctors changed shifts, although less than half (45.7%, n = 95) wanted to be informed when these shift changes occurred. Almost all patients (88.9%, n = 185) wanted to know when their care was handed over to a new consultant. Overall, patients believed that mistakes sometimes happened due to poor handovers, as reflected by a median Likert score of 3.

Patient satisfaction with the handover processSatisfaction with overall handover process

Patients had good perception of handover processes, agreeing or strongly agreeing with all positive statements. They felt that their doctors worked well together as a team and that they were made aware of who their consultant was (median Likert score 5: strongly agree). Overall, they were not worried about mistakes happening when a new doctor took over their care (Fig. 1; median Likert score 2—disagree).

Fig. 1

Patient satisfaction with the handover process. Distribution of patient responses (strongly agree to strongly disagree) to statements assessing satisfaction with the handover process

Satisfaction with weekend care

Of the patients surveyed, 64.9% (n = 135) had a hospital stay that included at least part of a weekend. During this time, 87.4% (n = 118) were seen by a doctor, and 51.8% (n = 70) encountered a new doctor. Overall, patients reported higher satisfaction with how well new doctors understood their case the day after their admission compared with those they met on the weekend (Table 1 summarises patients’ perceptions—using a 5-point Likert scale—of new doctors’ understanding of (1) the reason for their admission, (2) their medical and surgical history, (3) their latest test results, and (4) the next steps in their treatment plan. Across all four questions, satisfaction scores were significantly higher for the day-after-admission group compared with weekend encounters (*p < 0.05, Wilcoxon rank-sum test).

Table 1 Patients satisfaction with new doctor knowledge the day after admission versus the weekendQualitative analysis

A total of 62 free-text comments pertaining to handover or communication were provided by 39 respondents. Thematic analysis identified four themes: (1) the impact of poor interprofessional communication, (2) the importance of teamwork amongst staff, (3) external factors influencing handover effectiveness, and (4) patients adopting a passive approach to their care (Table 2).

Table 2 Themes identified during thematic analysisThe impact of poor interprofessional communication

Patients frequently expressed frustration with having to repeat their medical history and receiving conflicting information from staff. Poor communication among staff was associated with patient distress, worsening of symptoms, and the need for patients to correct misinformation at the bedside. Concerns were also raised regarding incomplete tasks, delayed treatments, and premature discharge from hospital (Table 2).

“I was discharged I feel prematurely. The doctor covering my care was not part of the team I believe and failed to check a drain I had attached which was not working correctly.” – Respondent 105

The importance of teamwork

A collaborative management approach contributed to positive patient experiences. Perceptions of effective teamwork also reassured patients about staff’s familiarity with their care.

“All doctors acted as one team with key goal getting me well, monitoring my progress and creating a clear recovery plan.” – Respondent 135

“Everyone I spoke to on the weekend knew what was going on and I didn’t need to really explain anything to anyone.” – Respondent 159

External factors influencing handover effectiveness

Patients identified staff availability, a lack of electronic patient records, and the accuracy of written handover as factors affecting handover effectiveness. Challenges associated with hospital stays over the weekend were also reported, including unfamiliar staff, reduced frequency of patient reviews, limited staff availability, and delays in investigations and procedures.

“..information created should be digital too much paper work can sometimes lead to mistakes” – Respondent 135

“Felt like everything was a bit slower to progress on the weekends. Feels like you are waiting on your [doctor] and surgeon to come back to work to get any MRI/ops etc booked in.” – Respondent 137

Nonchalance about their care

Some patients expressed disinterest in understanding or engaging with the handover process, preferring to entrust this professional activity entirely to the medical team. One patient stated:

“They should just do what they do, I have no interest in a handover being explained to me.” – Respondent 155

“The doctors knew what they were doing, I don’t think they would ever make a mistake. I trust them and it does me no good to be worrying about them making mistakes. I just want to get better and leave it all to them” – Respondent 157