title: Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case studies.
abstract: OBJECTIVE
  Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. The purpose of this paper is to broaden our understanding of clinical handover as a patient safety issue, and to identify socio-technical issues which may come to bear on the success of computer based handover tools.
  
  
  METHODS
  Three in depth ethnographic case studies were undertaken. Field notes were transcribed and analyzed with the aid of qualitative data analysis software. Within case analysis was performed on each case, and subsequently, cross case analyses were performed.
  
  
  RESULTS
  We identified five types of socio-technical issues which must be addressed if electronic handover tools are to succeed. The inter-dependencies of these issues are addressed in relation to arenas in which health care work takes place.
  
  
  CONCLUSIONS
  We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover, and issues related to data standards and system interoperability must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care.
authors.affiliation: School of Communication, Simon Fraser University, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health, Canada. Electronic address: ellenb@sfu.ca.
authors.forename: Ellen
authors.initials: E
authors.lastname: Balka
authors.forename: Marianne
authors.initials: M
authors.lastname: Tolar
authors.forename: Shannon
authors.initials: S
authors.lastname: Coates
authors.forename: Sandra
authors.initials: S
authors.lastname: Whitehouse
mesh_terms: D000884:Anthropology, Cultural; D003266:Continuity of Patient Care; D006751:Hospital Information Systems; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D061214:Patient Safety; D010360:Patient Transfer / Q000458:organization & administration*; D017751:Safety Management; D012865:Skiing / Q000293:injuries; D057188:Workflow