Clinical handover

Clinical handover is the transfer of responsibilities and accountability from clinicians to patients as well as scaring for them. Although it is beneficial to the patients by prolonging their life, is a risky event of communication in hospital practices. As a result, Australia departments of health and management of hospitals have established standard protocols for use during hand over processes.

The paper concentrates on ISBAR tool as an introduced protocol and finds its problems that may affect proper handover practices. It analyzes audio-recorded shift-change clinical handovers conducted between clinicians. The paper identifies various modes of communication that lead to poor handover. It   explains the importance of concentrating on proper open communications. In addition, the paper stresses on safety and quality of interaction sin healthcare organizations. Qualitative methodology with Semi-structured observations and interviews conducted on clinicians on duty and incoming. Iterative review analyzed observed data by research team members. Content analysis analyzed interviews. Results indicated that although ISBAR tool is effective it  concentrates on the outgoing nurses without giving room for incoming nurses to give their suggestions. As a result various modifications requires to be done on ISBAR tool as well as establishment of other more efficient tools.



Introduction and background

Clinical handover is a vital event in nursing practice and hospitals and occurs at different times and settings. Communication determines awards when discharging patients. Clinical handover can be done on permanent or temporary terms (Australian council for safety and quality in healthcare, 2005). The problems were found compared to the proper  proposed handover process that states that communications during handover should be conceptual, inherent, interactive and ones that describes the model and practice which must be interactive an informational .

Various studies conducted on the causes of mortality, incidents and injuries of patients in hospitals indicate poor communication between the nurses and patients as well as ineffective methods of transferring clinical care (Eggigs &Slade, 2012). As a result, Australia departments of health and management of hospitals have established standard protocols for use during hand over processes.

Importance of clinical handover process

The main aim of a handover process is to ensure efficient communication of higher-quality clinical information and transfer of responsibility for patient care (Australian medical association, 2006). A proper handover process ensures prioritization of tasks enables planning for future care and their management and ensures that unstable patients are attended in a timely manner. Unstable patients are reported to the senior clinicians on time. In addition, junior team members are briefly adequately on previous shifts. The incoming teams (Australian medical association, 2006) properly understand incomplete tasks.

Aim of the study

The study aims to evaluate shift-to-shift handover practices practiced by clinicians in healthcare organizations against protocols offered. It also aims at giving recommendations on how to improve clinical handover practices in hospitals (Eggins &Slade, 2012)..

Forms of clinical handovers

Studies done in Australian hospitals indicate that most handovers are done verbally face-to-face between clinicians who are outgoing and ones who are getting into the hospitals. Handovers may be scheduled or unscheduled. Scheduled handovers may happen at the patient’s rooms, wards, white boards, meeting rooms, during ward rounds, in nursing stations or discharge lounges. Unscheduled handovers occur in hospital corridors, through phones, outside work times, during coffee breaks and meal times. The paper singles out scheduled handovers done face to face and occurring between doctors during formal shift changes.

Significance of the study.

The study on scheduled handovers was done because of the high nature of risk present when changing responsibilities of patients among clinicians. In addition the urge to improve on the area to better care given by clinicians in hospitals. Lastly shift changing and handover of patient care often leads to discontinuity of care, malpractice, and greater adverse effects. Such factors may be caused by lack of enough to effectively communicate the care being passed over and enough space left for such vital tasks. Frequent nurse interruptions are the greatest cause of careful handover practices. As a result, most nurses have expressed problems with handover practice.

The background of ISBAR communication protocol

ISBAR protocol of communication outlines various stages that exchanging clinical officers have to follow and help the incoming nurses on duty to understand. The protocol requires the outgoing nurse to identify himself or herself, give the situation of the patient, age and other important aspect. In addition, the nurse is asked to explain the background of the present problem, assess the patient present condition, and state the risks and urgent needs (Pascoe, 2014). Finally, the nurse should offer recommendations for patient care by outlining the treatment plan supposed. The protocol could assist in use of proper communication strategies when conducting handover procedures. However, few nurses practice the protocol due to lack of enough time space to pass enough information to incoming nurses. In addition, factors such as culture and institution as well as language barrier contribute to reluctant nature of its uptake.


Most nurses complain that they always get incomplete and unstructured information. A study conducted on handovers from emergency departments in 2007 indicates 15.4% cases transferred inadequate information, which resulted in adverse events(Eggins and Slade,2012) There were omissions in pending tests, medications, and active problems. Moreover there lacked proper face-to-face discussions on the a result the incoming clinicians found it difficult to take over care of patients. 95% of the nurses did not believe in formal handover processes (Eggins and Slade, 2012). The rest complained of a lack of structured and consistent approaches of handovers from emergency departments and ICUs.

Language was a barrier to record protocol offered due to lack of a collaborative social activity (genre) passed through language.

ISBAR protocol has two limitations in that it is momologic in nature. It concentrates on the contribution of the person handing over while no space to indicate the role of the person taking over the roles. Secondly, it majors on the informational handover content without considering interactive communication dimensions (Australian council for safety and quality in healthcare, 2005).


A team from the University Technology Sydney (UTS) conducted a survey on uptake and communication effectiveness of handover ISBAR protocol offered to medical officers in an Australian Public Hospital. Prior to the survey, clinicians had undergone training and encouragements to appreciate the use of handwritten handovers. A qualitative methodology was conducted through audio recording of ten handover events that involved shift changing. The findings were transcribed and de-identified (Chaboyer, McMurray, &Wallis, 2009) . There were doctors in each event who handled over four to eight patients to the other incoming team. The discussion involves two extracts from one morning shift handovers. The extracts represent different types and ranges of communicative behavior recorded in the hand over corpus. In addition they can be used to shed light on communication behavior since they show contrasting ways of managing handover interactions.

Data collection

Semi-structured observations and interviews were conducted on clinicians on duty and incoming. Patients were included in the data collection procedures to get their perspectives. Audio-taped in depth interviews were conducted together with inclusion of purposive sampling in the handovers. Questions majored on issues related with communication in the handover processes and the perceived outcomes (Chaboyer, McMurray, &Wallis, 2009) .

Data analysis

Iterative review analyzed observed data by research team members. Content analysis analyzed interviews which involved grouping of data around central and recurring ideas. The analysis was iterative in that team members examined the interview data in a recursive way in search of similarities over all cases. Similar ideas were grouped into structures, processes and perceived outcomes (Chaboyer, McMurray &Wallis, 2009) .


The team found that communication on emergency departments was frequently interrupted as clinician competed for attention. The levels of noise were high and time pressure was extreme (Australian Medical association, 2006). There were interactions between patients and clinicians and among senior and junior clinicians.

            Interruptions and absences

Findings indicate that nurses were interrupted by their mobile phones making them play no care or obligation at all. Others have a shared conversation at one time in the shift (Masterson, 2008). The interruptions brought unprepared handovers since they lacked proper attention.

            Differential participation

Although most nurses are present during the handover, few are absent and inactive at the time. A large number of doctors use a monologue style of handing over, through use of fluent communication style and confidence. In addition, they take handover process serious and avoid any interruptions. Other uses the structured presentation such as ISBAR protocol to record clinical information logically (Chaboyer, 2011). A larger proportion of outgoing nurses records the present situation of their patient in a hurry without being concise with the information given. Nurses reporting in exchange check the provided information and seek clarification of the location of the patient, procedures to be taken, advice and implications. Such clinicians are not confident of their work and assertive on their roles.


The team concluded that most nurses bury important events that should have been done on the patients in the handover process. Other do not offer follow up statements on the outcomes. As a result, they give wrong recommendations for ongoing care. Other s provide tentative and vague care due to lack of knowledge in facts establishment process. Lack of confidence and poor presentation of information causes the incoming nurses to rely of dialogic elicitation through other interact ants. In addition, poor communication and interaction skills deteriorate relationships at work.

Management in turn taking

Institutions require strict handover processes that are specific on context and ones that allows interactions other than casual communications. The handover protocols for use should focus on the goals of the organization, accountability, and responsible patient care (Masterson, 2008).

Communication skills that help a clinician give a stronger handover

A strong handover should involve nurses who are assertive to retain the floor. The handing over nurse should introduce the patient and ensure that they have handed responsibilities and attention to the nurses in the next shift. They should use expressions and signals in their communications (National clinical guideline, 2014). They should avoid frequent hesitations and hold their breath to deliver proper information. In addition, they should be fluent in their delivery of information. Proper information skills require that before end of handover process the nurse should clarify the name and location of the patient, diagnosis, and recommendations on the patient. All nurses should ask for clarifications on the information offered (Memoire, 2007).


ISBAR protocol assist outgoing clinicians in structuring information thus offering useful tools for junior staffs. However, clinicians require to be trained on multi-party interactions to achieve effective purposes during the clinical handovers. Moreover, they should engage in benchmarking activities. Australian Commission on safety and quality in healthcare (2012) recommends development of underpinning policies and procedures that ensure present clinical handover that is active in various levels within the organization.



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