Dear authors thank you for the opportunity to read and review your interesting manuscritp. You have conducted a very complex and rich study. I have read the article with interest, however some points of the manuscript are a bit confusing and need to be revised. I hope that my suggestions will help you to improve its quality.

ABSTRACT
Method: please report in which hospital wards did you conduct the study.

THE STUDY
Design
page 4 Lines 40-42: I suggest to move the first sentence "The multidisciplinary research team was led by an applied linguist and included nurse–researchers, nurses and linguist research assistants (all female)" after the description of the design you adopted for the study. Furthermore, I suggest to declare in this section that this study is a part of a large multisite-study.

Sample and participants
A brief description of the ward where you conducted the study is recommended, including more information about the handover methodology used before your intervention.

Data collection
Please report the number of participants to the focus groups.
Furthermore, in this section more information about the sample are needed (e.g., years of work experience of professionals and their role; degree; gender; for nursing students in the academic year they were attending; ect.)

Data Analysis
In order to help the reader better understand how you analysed the data it would be useful to report in more detail on the procedures you used,especially how did you analyse and integrate the data from the interviews with the Focus Group data and the observations/video recordings.

Page 7 lines 17-44 please review this part of the manuscript because is quite complex and and sometimes confused.

Results
The tables 1, 2, 3 and 4are interesting but the fact that you have a lot of focus on specific interviews could lose the results of the other. I suggest to review this part of the manuscript by integrating it with all the data you have collected.

Page 13 Phase2: the intervention.
in the first part of this section the intervention is clearly indicated, unlike the part of the method. i suggest to move this description in the method section and here focus only on the results.

3.3.3 Impact on patient outcomes
Page 18 lines 3-15. Here you have reported the data showing an improvement of the patient outcome after your surgery, however the previous data are missing. I suggest you report them in order to help the reader to better understand your results

Discussion
the arguments are interesting but it is necessary improve the comparison with the available literature. Please review this part of the manuscript.