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Qual Saf Health Care 18:244-245 doi:10.1136/qshc.2009.032946
  • Commentary

Improving clinical handovers: creating local solutions for a global problem

  1. Julie K Johnson1,
  2. Vineet M Arora2
  1. 1
    Centre for Clinical Governance Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
  2. 2
    University of Chicago, Chicago, Illinois, USA
  1. Dr Julie K Johnson, Centre for Clinical Governance Research in Health, Sydney, NSW 2052, Australia; j.johnson{at}unsw.edu.au

    The clinical handover serves as the basis for transferring responsibility and accountability of patient care from outgoing to incoming healthcare teams across shifts, across disciplines and across care settings.1 There has been a groundswell of interest in clinical handovers, which has taken shape in the form of research, policies, guidelines and quality improvement efforts. The buzz generated by these efforts has resulted in handovers jostling for top position as one of the hottest topics in the global patient safety arena. The World Health Organization (WHO) listed “Communication during Patient Care Handovers” as one of its High 5 patient safety initiatives.2 Improving effective communication throughout the hospital is a lead patient safety goal put forth in the USA by The Joint Commission.3 The Australian Commission on Quality and Safety in Health Care (ACQSC) has identified clinical handovers as a particular focus for 2009.4 Policies and guidelines for handovers extend to physician trainees as well, as evidenced by the guidelines put forth by the Junior Doctors Committee of the British Medical Association.5 The Institute of Medicine in the USA has also recommended that “all trainees receive formal training in handoff communications.”6 In essence, interest in the communication act during a transition of care—whether we call it a handover, hand-off or sign-out—has grown steadily over the past decade as researchers, hospital administrators, educators and policy makers have come to realise that the potential breakdown in communication during patient handover is a serious issue affecting their institutions, their clinicians and their patients.

    As the research has burgeoned, there are several simple points on which most researchers agree:179

    • Handovers are a vulnerable time in patient care.

    • There is little standardisation and great variation across disciplines and healthcare organisations in the ways in which handovers are …