Does clinical handover promote situation awareness? Implications for person-centered healthcare

Main Article Content

Cinzia Pezzolesi
Tanya Manser
Fabrizio Schifano
Andrzej Kostrzewski
John Pickles
Harriet Nicholls
Daniel Fishman
Arshad Mubarik
Soraya Dhillon


Background: Doctors’ handover has been the subject of investigation since the implementation of the European Working Time Directive in 2004. Little is known regarding handover quality and safety in clinical practice. This study aims to systematically assess handover practice across different clinical settings and to consider its implications for person-centered healthcare.Method: Prospective observational study of handover practice over a period of three weeks in the Obstetrics-Gynaecology, Acute Care Unit and General Surgery departments of one UK General District Hospital. Checklists developed on the basis of the Royal Colleges of Surgeons’ and Physicians’ guidelines were used to assess clinical practice.Results: A total of 306 patients were admitted in the departments during the study period; 45 patients (15%) were not handed over during the change of the shift. Accuracy of handover compared to our gold standard were:  Obstetrics-Gynaecology (45%); Acute Medicine (51%); General Surgery (52%). Information less likely to be handed over was related to patients’ management plan in all specialities. Medicine and Surgery rarely discussed aims and limitations of treatments while Obstetrics-Gynaecology handed over tasks to be done only in 43% of patients. All specialties performed well during the handover of current diagnosis and list of patient problemsConclusions: A number of weaknesses were identified in handover practice across the clinical settings explored. The existing handover process focuses on the current status of patients, whereas safety concerns, time critical actions. Anticipated next steps should address the lack of the so called ‘third level’ of situation awareness as one method aimed at improving the person-centeredness of clinical services.

Article Details

Regular Articles
Author Biography

Cinzia Pezzolesi, School of Pharmacy, University of Hertfordshire, Hatfield, UK

Research Fellow, School of Pharmacy, University of Hertfordshire, Hatfield, UK


Goddard, A., Pounder, R., McIntyre, A. & Newbery, N. (2009). Implementation of the European Working Time Directive in 2009 – implications for UK clinical service provision and training for the medical specialties. Royal College of Physicians of London, 2009. Available at Accessed 24 February 2010.

Al-Benna, S., Al-Ajam, Y. & Alzoubaidi, D. (2009). Burns surgery handover study: trainees' assessment of current practice in the British Isles. Burn 35 (4) 509-512.

AHCC. (2007). National Clinical Handover Initiative: Nursing and Medical Handover in General Surgery, Emergency. Medicine and General Medicine at the Royal Hobart Hospital. Available from:$File/Minimum%20Data%20Set%20TASDept.pdf. Accessed 04 February 2009.

WHO. (2006). Communication during patient hand-overs. Patient Safety Solutions. Volume 1, solution 3. Available at: Accessed 20 February 2010.

British Medical Association. Safe handover: safe patients. Available at: Accessed 19 January 2009.

Royal College of Physicians. (2005). General professional training guide. London: Royal College of Physicians. Available at: Accessed 24 February 2009.

Royal College of Surgeons of England. (2007). Safe handover: guidance from the Working Time Directive working party. London: Royal College of Surgeons.

Manser, T. & Foster, S. (2011). Effective handover communication: an overview of research and improvement efforts. Best Practice & Research. Clinical Anaesthesiology 25 (2) 181-191.

Pickering, B.W., Hurley, K. & Marsh, B. (2009). Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover. Critical Care Medicine 37 (11) 2905-2912.

Borowitz, S.M., Waggoner-Fountain, L.A., Bass, E.J. & Sledd, R.M. (2008). Adequacy of information transferred at resident sign-out (in-hospital handover of care): a prospective survey. Quality & Safety in Health Care 17 (1) 6-10.

Evans, S.M., Murray, A.L., Fitzgerald, M., Smith, S., Andrianopoulos, N. & Cameron, P. (2009). Assessing clinical handover between paramedics and the trauma team. Injury 41 (5) 460-464.

Sabir, N., Yentis, S.M. & Holdcroft, A. (2006). A national survey of obstetric anaesthetic handovers. Anaesthesia 61 (4) 376-380.

Bhabra, G., Mackeith, S., Monteiro, P. & Pothier, D.D. (2007). An experimental comparison of handover methods. Annals of the Royal College of Surgeons of England 89 (3) 298-300.

Nemeth, N. (2008). Improving healthcare team communication. Available at: Accessed 13 March 2009.

US Department of Defence. (2005). Patient Safety programme. Health care communication toolkit. Available at: Accessed 24 February 2009.

King, R. & Hirst, R. (1998). Four other major accidents. In: Kings Safety in the Process Industries, pp. 83-108. Amsterdam: Elsevier.

Raduma-Tomàs, M.A., Flin, R., Yule, S. & Close, S. (2010). Doctors' Handovers in an acute medical assessment unit: A Hierarchical Task Analysis. Paper presented at the Human Factors and Ergonomics Society 54th Annual Meeting, San Francisco, CA.

Jeffcott, S.A., Evans, S.M., Cameron, P.A., Chin, G.S. & Ibrahim, J.E. (2009). Improving measurement in clinical handover. Quality & Safety in Health Care 18 (4) 272-277.

Breakwell, G.M., Hammond, S., Fife-Schaw, C. & Smith, J. (2006). Research methods in psychology. Chapter 16, Rudi Dallos, Observational methods. London: Sage.

Nagpal, K., Abboudi, M., Fischler, L., Schmidt, T., Vats, A., Manchanda, C., Sevdalis, N., Scheidegger, D., Vincent, C. & Moorthy, K. (2011). Evaluation of postoperative handover using a tool to assess information transfer and teamwork. Annals of Surgery 253 (4) 831-837.

Cook, R., Render, M. & Woods, D. (2000). Gaps in the Continuity of Care and Progress on Patient Safety. British Medical Journal 320 (7237) 791-794.

Flin, R., Martin, L., Goeters, K., Hoermann, J., Amalberti, R., Valot, C., et al. (2003). Development of the NOTECHS (Non-Technical Skills) system for assessing pilots’ CRM skills. Human Factors and Aerospace Safety 3 95-117.

Yee, K.C., Wong, M.C. & Turner, P. (2006). Medical error management and the role of information technology--a new approach to investigating medical handover in acute care settings. Studies in Health Technology and Informatics 124 679-684.