title: Handover in the emergency department: deficiencies and adverse effects.
abstract: OBJECTIVE
  To determine problems resulting from ED handover, deficiencies in current procedures and whether patient care or ED processes are adversely affected.
  
  
  METHODS
  A prospective observational study at three large metropolitan ED comprising three components: observation of handover sessions, 2 h post-handover surveys of the receiving doctors and a general survey of ED doctors.
  
  
  RESULTS
  The handovers of 914 patients were observed during 60 handover sessions in a 3-month period. Medical information, including presenting complaints, was handed over better than communication and disposition information. Seven hundred and seven (77.4%) of 914 potential post-handover interviews were undertaken. Most (88.3%) doctors thought the handover was 'adequate/good'. However, information was perceived as lacking in 109 (15.4%) handovers, especially details of management (35, 5.0%), investigations (33, 4.7%) and disposition (33, 4.7%). There was a significant difference in the perceived quality of handovers (1-5 scale where 5 = excellent) when all required information was handed over and when it was not (median scores 4.0 vs 3.0, respectively, P < 0.001). As a result of perceived inadequate handovers, the doctor/ED and patient were affected adversely in 62 (8.8%) and 33 (4.7%) cases, respectively, for example, repetition of assessment, delays in disposition and care. Fifty doctors completed the general survey. Most believed communications made to inpatient units, inaccurate/incomplete information and disorganization were problematic.
  
  
  CONCLUSIONS
  Deficiencies in handover processes exist, especially in communication and disposition information. These affect doctors, the ED and patients adversely. Recommendations for improvement include guideline development to standardize handover processes, the greater use of information technology facilities, ongoing feedback to staff, and quality assurance and education activities.
authors.affiliation: Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Ye
authors.forename: David
authors.initials: D
authors.lastname: McD Taylor
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Knott
authors.forename: Andrew
authors.initials: A
authors.lastname: Dent
authors.forename: Catherine E
authors.initials: CE
authors.lastname: MacBean
mesh_terms: D001315:Australia; D003142:Communication; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006757:Hospital Units; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010347:Patient Care Planning; D010360:Patient Transfer; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome