BMJ Qual Saf doi:10.1136/bmjqs-2011-000308
  • Original research

Avoiding handover fumbles: a controlled trial of a structured handover tool versus traditional handover methods

  1. Daniel D Dressler
  1. Division of Hospital Medicine, Department of Medicine; Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Christina Payne, Emory University, 1365 Clifton Road, Clinic A Building A4321, Atlanta, GA 30322, USA; cbpayne{at}
  1. Contributors CEP: Study conception and design and implementation, data analysis, drafting of manuscript, final approval of manuscript. JMS: Study conception and design, critical revisions, final approval of manuscript. DDD: Study conception and design, critical revisions, final approval of manuscript.

  • Accepted 22 May 2012
  • Published Online First 16 June 2012


Background Handover of patient information represents a critical time period during a patient's hospitalisation. While recent guidelines promote standardised communication during these patient care transitions, significant variability in structure and practice persists among hospitals and providers.

Methods The authors surveyed internal medicine residents regarding handover practices before and after introduction of a structured, web-based handover application. The handover application standardised patient data in a format suitable for both patient handovers and day-to-day patient management.

Results A total of 80 residents were surveyed prior to the intervention (80% response rate) and 161 residents during the intervention (average 68% response rate for all surveys distributed). At baseline, residents perceived deficits in handover practices related to the variability of information transferred and correlated that variability to near-miss events. After introduction of the handover application, 100% of handovers contained an updated problem list, active medications, and code status (compared to <55% at baseline, p<0.01); residents perceived approximately half as many near-miss events on call (31.5% vs 55%; p=0.0341) and were twice as likely to respond that they were confident or very confident in their patient handovers compared to traditional practices (93% vs 49%; p=0.01).

Conclusion Standardisation of information transmitted during patient handovers through the use of a structured, web-based application led to consistent transfer of vital patient information and was associated with improved resident confidence and fewer perceived near-miss events on call.


  • The authors have no financial or proprietary interest in any product mentioned herein. Data have been previously presented at the annual meetings of the Society of Hospital Medicine (SHM) and the American College of Physicians (ACP).

  • Competing interests None.

  • Ethics approval Emory University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data available upon request from corresponding author.

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