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Interventions employed to improve intrahospital handover: a systematic review
  1. Eleanor R Robertson1,
  2. Lauren Morgan1,
  3. Sarah Bird2,
  4. Ken Catchpole3,
  5. Peter McCulloch1
  1. 1Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
  2. 2University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
  3. 3Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California USA
  1. Correspondence to Mrs Eleanor R Robertson, Nuffield Department of Surgical Sciences, University of Oxford, Level 6, John Radcliffe Hospital, Headington, Oxford , Oxfordshire OX3 9DU, UK; eleanor.robertson{at}


Background Modern medical care requires numerous patient handovers/handoffs. Handover error is recognised as a potential hazard in patient care, and the information error rate has been estimated at 13%. While accurate, reliable handover is essential to high quality care, uncertainty exists as to how intrahospital handover can be improved. This systematic review aims to evaluate the effectiveness of interventions aimed at improving the quality and/or safety of the intrahospital handover process.

Methods We searched for articles on handover improvement interventions in EMBASE, MEDLINE, HMIC and CINAHL between January 2002 and July 2012. We considered studies of: staff knowledge and skills, staff behavioural change, process change or patient outcomes.

Results 631 potentially relevant papers were identified from which 29 papers were selected for inclusion (two randomised controlled trials and 27 uncontrolled studies). Most studies addressed shift-change handover and used a median of three outcome measures, but there was no outcome measure common to all. Poor study design and inconsistent reporting methods made it difficult to reach definite conclusions. Information transfer was improved in most relevant studies, while clinical outcome improvement was reported in only two of 10 studies. No difference was noted in the likelihood of success across four types of intervention.

Conclusions The current literature does not confirm that any methodology reliably improves the outcomes of clinical handover, although information transfer may be increased. Better study designs and consistency of the terminology used to describe handover and its improvement are urgently required.

  • Hand-off
  • Implementation Science
  • Quality Improvement
  • Quality Improvement Methodologies
  • Transitions In Care

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