title: Conceptualizing handover strategies at change of shift in the emergency department: a grounded theory study.
abstract: BACKGROUND
  The importance and complexity of handovers is well-established. Progress for intervening in the emergency department change of shift handovers may be hampered by lack of a conceptual framework. The objectives were to gain a better understanding of strategies used for change of shift handovers in an emergency care setting and to further expand current understanding and conceptualizations.
  
  
  METHODS
  Observations, open-ended questions and interviews about handover strategies were collected at a Veteran's Health Administration Medical Center in the United States. All relevant staff in the emergency department was observed; 31 completed open-ended surveys; 10 completed in-depth interviews. The main variables of interest were strategies used for handovers at change of shift and obstacles to smooth handovers.
  
  
  RESULTS
  Of 21 previously identified strategies, 8 were used consistently, 4 were never used, and 9 were used occasionally. Our data support ten additional strategies. Four agent types and 6 phases of the process were identified via grounded theory analysis. Six general themes or clusters emerged covering factors that intersect to define the degree of handover smoothness.
  
  
  CONCLUSIONS
  Including phases and agents in conceptualizations of handovers can help target interventions to improve patient safety. The conceptual model also clarifies unique handover considerations for the emergency department setting.
authors.affiliation: Center for Quality Improvement and Research 14(W), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106, USA. renee.lawrence2@va.gov
authors.forename: Renée H
authors.initials: RH
authors.lastname: Lawrence
authors.forename: Anne M
authors.initials: AM
authors.lastname: Tomolo
authors.forename: Andy P
authors.initials: AP
authors.lastname: Garlisi
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006282:Health Personnel; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D010347:Patient Care Planning / Q000458:organization & administration*; D000078329:Workforce; D016526:Workload