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BMJ Qual Saf 21:i9-i12 doi:10.1136/bmjqs-2012-001213
  • Viewpoint

The patient handover as an entrustable professional activity: adding meaning in teaching and practice

Open Access
  1. John Q Young3,4
  1. 1Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Medicine, University of California, San Francisco, California, USA
  3. 3Department of Psychiatry, University of California, San Francisco, California, USA
  4. 4Department of Psychiatry, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
  1. Correspondence to Dr ThJ (Olle) ten Cate, Center for Research and Development of Education, University Medical Center Utrecht, P.O. Box # 85500, 3508 GA Utrecht, The Netherlands; t.j.tencate{at}umcutrecht.nl
  • Accepted 26 September 2012

Major healthcare reform, including limits on work hours for health professionals and the involvement of multiple individuals, teams and settings have made handovers a common and frequent aspect of patient care. Research has shown that errors commonly occur during handovers, and can result in patient harm.1 ,2 As a result, healthcare systems, at the behest of regulatory agencies, must now ensure that handover processes are safe and reliable. Similarly, medical education programmes and credentialing bodies are required to monitor clinician competence with respect to handovers.

Developing valid measures of clinician competence is a major challenge. The handover requires the application and integration of clinical and communication skills, and an understanding of the systems of care, which must come together in one, time-limited and highly constrained activity.3 ,4 Acquiring the ability to perform this activity well is, because of its complexity, not a simple linear process and requires years to perfect. A trainee cannot be asked to study it from a book, or practice in a course, with the expectation of a satisfactory score on a skills assessment. The quality of handing over patient information and responsibility is highly provider and context-dependent and case-specific. Because many doctors do it on a daily basis, it must be learned in training and the competence to do this should be assessed. Well trained physicians should be trusted to provide adequate information in handovers, and recipient doctors and other healthcare professionals must understand, accept and appropriately apply this information to guarantee optimal care.

Policy makers and educators have called for added training of healthcare professionals to improve their skills and competence for conducting handovers. The European HANDOVER Project encompassed several initiatives to improve the education and training of healthcare professionals in this important area of patient safety and continuity of care. …