Abstract: Objective: To develop the nursing handover index for patients undergoing hip/knee arthroplasty with downward referral in order to ensure the comprehensive and scientific contents of the handover, and to optimize the referral process. Methods: Guided by the ISBAR communication model, the index system and the weight of each index were determined by literature review, Delphi method and analytic hierarchy process. Results: The recovery rates for the first and second rounds of the study were 96.7% and 92.3%, respectively. The expert judgment coefficient was 0.98, the expert familiarity was 0.86, and the expert authority was 0.92, respectively. Finally, the index system for downward referral of hip/knee replacement patients included 5 first-level indicators, 17 second-level indicators and 59 third-level indicators. Conclusion: The nursing handover index of downward referral for hip/knee arthroplasty patients established in this study can provide scientific and comprehensive downward referral reference for clinical nurses, and provide theoretical basis for the construction of a referral platform for outpatients.

Key words: hip replacement; knee replacement; medical union; downward referral; nursing handover; index