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Effective handover communication: An overview of research and improvement efforts

https://doi.org/10.1016/j.bpa.2011.02.006Get rights and content

In the recent patient safety literature, there is an increasing agreement that effective patient handover is critical to patient safety by ensuring appropriate coordination among health-care providers and continuity of care. It has repeatedly been pointed out that a lack of formal training and formal systems for patient handover impede the good practice necessary to maintain high standards of clinical care. Thus, patient handover has been defined a research priority for patient safety, and research in this field is increasing rapidly. In reviewing the current state of research and improvement, we identified key areas for future research. Despite the growing evidence at the descriptive level, future research will have to take a more systematic approach to establish valid measures of handover quality and safety, establish the causal effects of handover characteristics on safe care and identify best practices in safe handover and effective interventions within and across health-care settings.

Section snippets

Patient handover as a priority of patient safety research

Patient care is an inherently communicative activity. It is therefore not surprising that communication issues are among the most frequent contributory factors of adverse events identified in retrospective adverse-event analyses4, 5, 6 and that several observational studies highlight the frequency and negative consequences of communication breakdowns.7, 8, 9

Communication processes are particularly vulnerable at organisational interfaces, such as care transitions and shift changes. The

What is the current handover practice?

Studies describing handover practice show significant variation within and across health-care settings. Despite these variations, four phases have been identified in patient handover in clinical settings: pre-handover, arrival, handover meeting and post-handover.25, 26Especially for handovers of multiple patients at a time, it has been shown that pre-handover preparation – one of the safety-critical handover strategies identified in high-reliability organisations15 – is often insufficient.22, 27

Moving handover research and improvement efforts forward

Based on this overview, two areas in handover research emerge that deserve an accentuated focus in the future: (1) improved research designs to overcome current methodological problems and (2) broadening the understanding of patient handover to a team task and not just a one-way transfer of information.

Conclusions

There is wide agreement that patient handover is a key process to improve patient safety, and that formal systems for patient handover combined with formal training on effective handover communication will promote patient safety in all areas of health-care.1, 16, 17, 90

It has been pointed out that human factors’ research is integral to interdisciplinary research aimed at understanding and improving patient handover.90 The contribution of human factors’ science in supporting current research and

Conflict of interest

None.

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