Clinical handover

Clinical handover is the transfer of professional responsibility for some or all aspects of patient care to another. This handover may be temporary or permanent, and may involve multiple patients and professionals. Professional responsibility includes accountability, responsibility, and information about care and condition. Workload, communication styles, fatigue, and hierarchies are among factors that hinder clinical handover.

Overview

Clinical handover generally occurs as a handoff, also known as handover, shift report, sign-out, and sign-over, usually as part of a shift change—for example, when nurses on one hospital shift prepare to leave while the nurses on the next shift prepare to take over patient care. Other examples include handoffs between nursing units or settings (such as emergency room and operating room), handoffs between physicians, and handoffs involving patient discharge or transfer to another facility.

Many medical mistakes have been attributed to poor handoff. For this reason, a number of countries, including the United States, Australia, and Great Britain, have studied the topic and established best practices for clinical handover. Concerns include communication about condition, follow-up care, and medication. Errors may range from transferring a patient with incomplete medical records, which may delay proper care or result in prescription errors, to operating on the wrong body part, which may result in death or permanent disability.

Clinical handover requires communication. This is achieved in an open and accepting environment—for example, a hospital in which less-experienced staff are encouraged to ask questions, and experienced staff willingly share information. Methods may include electronic, verbal, or written reports; bedside handovers, which include the patient in the discussion; and telephone handovers. These methods have strengths and weaknesses. For example, a verbal bedside report includes the patient, who can correct erroneous information and ask questions; however, information conveyed verbally may be forgotten, and the patient may not understand medical terms. Bedside reports are time-consuming, and some patients may not wish to participate. A written report, however, may not give care providers and patients an opportunity to ask questions. A medical facility, therefore, may require both a verbal and written report in a clinical handover. Such handovers have been cited by emergency department staff as a good opportunity for two health care providers to evaluate a situation and possibly discover unrecognized problems, which improves patient care.

According to Friesen et al. in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, the most effective clinical nursing handover method uses both a preprinted sheet of patient information and a verbal report. Participants retained between 96 and 100 percent of the information. The second-most effective was note-taking and verbal reporting, with information retention between 31 and 58 percent. A verbal-only method of handover resulted in retention between 0 and 26 percent.

Clinical handovers are especially important when patients are transferred between facilities, such as when a patient is discharged from a hospital and transferred to a rehabilitation center. Information is shared in written records, which may be lost in travel. The facilities and staff often have no professional interaction, which makes asking questions impossible or at least very difficult. Discharge planning is also important because follow-up care must be communicated to the patient, caregivers, and other medical professionals. Communication related to medication has been found to contribute to many adverse outcomes following discharge.

In the twenty-first century, the medical community has worked to establish different methods and frameworks to better aid in accurate clinical handovers. Some of these developments have included handover communication tools such as I-PASS (Illness severity, Patient information, Action list, Situational awareness and contingency plans, and Synthesis) and ISBAR (Introduction, Situation, Background, Assessment, Recommendation). However, it has been critiqued that some handover communication tools lack a solid theoretical basis, offer limited psychometric validation, and fail to incorporate key communication strategies that support diagnostic reasoning. This gap is significant, as communication failures during handovers have been linked to substandard patient care and malpractice, and account for 30 percent of malpractice claims in the US. BRIEF-C (Background, Responsible diagnosis, Included differential diagnosis, Excluded differential diagnosis, Follow-up, and Communication) was developed in hopes to bridge the gaps in already existing communication tools. Although, further studies are needed to validate the tool’s efficacy in enhancing handover communication and mitigating medical mistakes. Efforts by the Agency for Healthcare Research and Quality focus on improving handoff communication through digital tools and better interoperability between health information systems.

Bibliography

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Burciaga Valdez, R., et al. “AHRQ’s Digital Healthcare Research Program: 20 Years of Advancing Innovation and Discovery.” Journal of the American Medical Informatics Association, vol. 31, no. 11, 30 Sept. 2024, pp. 2766–71, doi.org/10.1093/jamia/ocae251. Accessed 2 Apr. 2026.

“Communication Strategies for Patient Handoffs.” American College of Obstetricians and Gynecologists, www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2012/02/communication-strategies-for-patient-handoffs. Accessed 2 Apr. 2026.

Fliesler, Nancy. “Safer Patient Handoffs.” Harvard Medical School, 18 Nov. 2014, hms.harvard.edu/news/safer-patient-handoffs. Accessed 2 Apr. 2026.

Friesen, Mary Ann, et al. “Chapter 34: Handoffs: Implications for Nurses.” Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality, 2008, www.ncbi.nlm.nih.gov/books/NBK2649/. Accessed 2 Apr. 2026.

“Handoffs.” Agency for Healthcare Research and Quality, US Department of Health and Human Services, 15 June 2024, psnet.ahrq.gov/primers/primer/9/handoffs-and-signouts. Accessed 2 Apr. 2026.

“ISBAR – Identify, Situation, Background, Assessment and Recommendation.” SA Health, Government of South Australia, 9 May 2022, www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/safety+and+wellbeing/communicating+for+safety/isbar+-+identify+situation+background+assessment+and+recommendation. Accessed 2 Apr. 2026.

Khalaf, Zahra. “Improving Patient Handover: A Narrative Review.” African Journal of Paediatric Surgery, vol. 20, no. 3, 2023, pp. 166–70, doi:10.4103/ajps.ajps_82_22. Accessed 2 Apr. 2026.

“Ossie Guide to Clinical Handover Improvement.” Australian Commission on Safety and Quality in Health Care, www.safetyandquality.gov.au/our-work/communicating-safety/clinical-handover/ossie-guide-clinical-handover-improvement. Accessed 2 Apr. 2026.

Rizzo, Ellie. “10 Patient Handoff Communications Tools.” Becker’s Healthcare, 4 Sept. 2014, www.beckersasc.com/asc-quality-infection-control/10-patient-handoff-communications-tools-2014.html. Accessed 2 Apr. 2026.