title: One size fits all? Challenges faced by physicians during shift handovers in a hospital with high sender/recipient ratio.
abstract: BACKGROUND
  The aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio.
  
  
  METHODS
  A multifaceted approach was adopted, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders' and recipients' verbal communication, and recipients' handwritten notes) and handover environmental factors were analysed. The relationship between 'to-do' tasks, and information transfer, handover quality and handover duration, were examined using analysis of variance.
  
  
  RESULTS
  Verbal handovers for 152 patients were observed; handwritten notes on 102 (67.1%) patients and handover quality ratings for the handovers of 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of nonmodifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication), allowed interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location.
  
  
  CONCLUSIONS
  Handovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised.
authors.forename: Xi Jessie
authors.initials: XJ
authors.lastname: Yang
authors.affiliation: Department of Industrial and Information Systems Engineering, College of Engineering, Soongsil University, 369SangdoRo Dongjak-Gu, Seoul, South Korea. tzpark@ssu.ac.kr.
authors.forename: Taezoon
authors.initials: T
authors.lastname: Park
authors.forename: Tien Ho Kewin
authors.initials: TH
authors.lastname: Siah
authors.forename: Bee Leng Sophia
authors.initials: BL
authors.lastname: Ang
authors.forename: Yoel
authors.initials: Y
authors.lastname: Donchin
mesh_terms: D000328:Adult; D003142:Communication; D003266:Continuity of Patient Care; D003625:Data Collection; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D062209:Patient Handoff; D061214:Patient Safety; D010820:Physicians; D012846:Singapore; D055815:Young Adult