Nursing handovers and patient safety: Findings from an umbrella review


  • 1 Department of Medical Sciences, University of Udine, Udine, Italy.
  • 2 School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy.
  • PMID: 31815307
  • DOI: 10.1111/jan.14288

Abstract in English, Chinese

Aims: To summarise available reviews on nursing handover (NH) and patient safety (PS), providing a set of evidence-based recommendations for clinical practice and research.

Design: Umbrella review.

Data sources: We systematically searched PubMed, CINAHL, and Cochrane Library CENTRAL databases up to October 2018.

Review methods: Retrieved reviews were critically evaluated using the Checklist for Systematic Review and Research Syntheses. Then, an iterative approach and two different frameworks were adopted to categorize the findings in: (a) practice; and (b) research recommendations.

Results: A total of 17 reviews were included: among them, 16 reported a range of recommendations for clinical practice to promote PS by reducing adverse events. For what concerns research, 16 reviews recommended specific strategies to improve and strengthen research and its quality in the field of NHs and PS.

Conclusion: Changing nursing handover practices to increase PS is complex: it means changing the culture, roles and behaviour of any given clinical nursing setting. To be effective, the change requires a tailored approach, time and implementation strategies including education and support. Future studies should address the flexibility required by handovers in daily practice and the multiple needs with the aim of increasing the robustness of the available evidence on NHs. These should also embrace the Complex Interventions Research Framework.

Impact: Several reviews have been performed as summaries of research and practice evidence on NHs, but no summary of the established clinical and research recommendations on NHs and PS has been provided to date. Standardized handovers supported by technological solutions, facilitating face-to-face contact between nurses, possibly alongside bedside reports, can improve PS. Well-designed longitudinal studies, on a wide scale, in different settings, based on a strong rationale and focused on measuring the association between handover and patients' safety issues are recommended.

目的: 总结针对护理交接(NH)与患者安全(PS)的现有评估结果,为临床实践和研究提供一套循证建议。 设计: 伞样综述。 数据来源: 我们对PubMed、CINAHL和Cochrane图书馆CENTRAL数据库截至2018年10月所发表的文献进行了系统搜索。 评估方法: 采用《系统评估和研究综合检查表》对所检索到的评估结果展开批判性评价。然后,采用迭代方法和两种不同的框架将发现结果分为两类:(a)实践结果;(b)研究建议结果。 结果: 共纳入了17项评估结果,其中有16项提出了一系列临床实践建议,通过减少不良事件来加强患者安全。针对研究关注问题,16项评估结果给出了提高并加强护理交接与患者安全领域研究及其质量的具体战略。 结论: 改变护理交接方式期以提高患者安全这一过程较为复杂:因为它意味着需改变任何特定临床护理环境的文化、角色和行为。为行之有效,这一改变需有量身定制的方法、时间和实施战略,其中包括学校教育和社会支持。未来研究应侧重于解决日常实践中交接工作所需的灵活性和多重需求,以期提高护理交接现有证据的稳健性。这还应包括复杂干预措施研究框架。 影响: 人们已针对护理交接研究和实践证据的总结开展了多项评估工作,但迄今为止尚未提供有关护理交接和患者安全既定临床和研究建议的总结结果。依赖于技术解决方案的标准化交接方式,不仅方便护士之间进行面对面接触,协同病床报告还可提高患者安全。我们建议开展不同环境下的较大规模、精心设计的纵向研究,依托于强大的理论基础,着重衡量交接工作与患者安全问题之间的联系。.

Keywords: nursing handover; patient safety; quality of care; recommendations; shift-to-shift handover; umbrella review.

© 2019 John Wiley & Sons Ltd.

Publication types

  • Systematic Review
  • Nursing Staff*
  • Patient Handoff*
  • Patient Safety*
  • Research article
  • Open access
  • Published: 28 January 2005

Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius

  • Hemant K Kassean 1 &
  • Zaheda B Jagoo 2  

BMC Nursing volume  4 , Article number:  1 ( 2005 ) Cite this article

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The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system.

A force field analysis in terms of the driving forces had shown that there was dissatisfaction with the traditional method of handover which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The restraining forces identified were a fear of accountability, lack of confidence and that this change would lead to more work. A 3 – step planned change model consisting of unfreezing, moving and refreezing was used to guide us through the change process. Resistance to change was managed by creating a climate of open communication where stakeholders were allowed to voice opinions, share concerns, insights, and ideas thereby actively participating in decision making.

An evaluation had shown that this process was successfully implemented to the satisfaction of patients, and staff in general.

This successful change should encourage other nurses to become more proactive in identifying areas for change management in order to improve our health care system.

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This study was undertaken in a 28 – bedded gynaecological ward catering for female patients aged 16 and above. There were 21 nurses based in this ward of whom 14 were qualified and the remaining were health care assistants, with experience ranging from 1 1/2 – 33 years. The shift handover in this ward was conducted as "a ritual inheritance," [ 3 ] distant from patients hearing and vision, such as the ward manager's office or the nurses' station, thus excluding patients participation in their care. The traditional handover used to consist of one-way communication, where the nurse in charge gave the relevant information and instructions to the nurses resuming their shift. A very salient feature of the handover was the absence of individual care planning and where all information about patients was either written in the ward diaries or in the patient files or nursing notes. The sample size of patients involved in the evaluation part of the study was 58.

The verbal handover was derived from written information on the office white board which included the patient's name, bed number, medical diagnosis and the treating doctor. This was in line with the findings of Sherlock [ 12 ] who argued that the shift handover was characterized by a focus on the biomedical model and marginalized the psychosocial aspects of care. The same style of reporting was repeated from one shift to another. As a result, the contents would sometimes degenerate into irrelevant and outdated statements, unrelated to the patient progress and often judgmental in nature with the likelihood of leading to omissions in care. It was therefore not uncommon that nurses were questioned on their practice by the ward manager or the treating doctor which gave rise to a blaming culture among nurses. There was also a level of dissatisfaction among patients who felt that they were not being involved enough in their care.

Diagnose need for change

The root cause of the problem identified was the model of handover used to communicate clinical information. As a benchmark, the findings from evidence on the bedside handover were used to give meaning and strength to the proposed change. Bedside handovers offer an immediate solution to the many problems that are associated with the traditional handover [ 5 , 15 , 16 ]. It has further advocated that bedside handover lay more emphasis on individualized patients care whereas bedside reporting is the most frequently used model of handover [ 5 ]. It puts the patients central to all care activities and does not rely purely on verbal information but which combines the key principle of patients/clients involvement and participation. In the same context, patients involved in handovers gain access to information that is thought to provide them with comfort and speed recovery [ 10 ]. Bed-side reporting makes it possible for nurses starting their shift to obtain a better insight into the care each patient requires [ 6 ]. Patients can discuss their health by asking questions and it was found to improve the consistency and continuity of patients care. The information style of bedside handover was informative, personal, shorter and comprehensive. In the light of the above findings, bedside handover had become a valid option for change in this ward.

Theories underpinning the change process

An adaptation of Spradley's 8-step model and Lewin's 3-step model of Unfreezing , Moving and Refreezing provided us with useful frameworks for our change management [ 9 , 14 ].

Unfreezing is about encouraging people think about the current situation and helping them recognise the need for change [ 5 ]. Change to be initiated requires a sense of direction and considerable power of leadership [ 8 ]. The authors were also guided by the work of Swansburg and Swansburg, [ 15 ] who argued that "transformational leaders are seen in health care organizations as a commitment to excellence."

The first move therefore was to create awareness by communicating the proposed change to all those who were going to be affected by the new practice: the nurses, patients and the ward manager so that they all had a shared vision of an improved handover system. A goal-seeking behavior with a clear logical sequence of action, were demonstrated throughout the process as advocated by Lancaster and Lancaster [ 8 , 17 ]. Research based articles were also used to demonstrate how this system was successfully implemented in different areas of the health care system.

The proposed change was announced in advance by using different communication channels, e.g. personal contact with individual nurses, staff information/notice board by the authors. This initiated informal discussion among nurses of the ward by creating a cognitive dissonance which led to a quest for more information about the new handover. This consultation phase allowed the nurses to discuss various clinical scenarios and analyse the constraints and benefits of the new proposal in the local context. They were also involved in group work to identify and make proposals on how to deal with some of the problems that we may encounter in our local context e.g. handover coinciding with ward rounds or emergency situations and patients too distressed to talk. Case studies and research articles on this topic were used for discussion and to further reinforce the beliefs of staff of the ward that the current practice had shortcomings and could be improved. The status quo was therefore unsettled and this enabled us to rule out the first resistance through a normative re-educative strategy. A group of senior nurses who had experience in this particular area agreed take turn to act as mentors in order to facilitate this process and offer support to their junior colleagues in the first week until they become confident to carry out the process without supervision.

Analysing the alternative options

The extensive literature search also provided us with options for alternatives to bedside handover. These were thoroughly debated before reaching a decision. The options considered were the following:

Tape recorded handover

Computer generated handover using information technology

Bedside handover, based on individualized care plan

The 'SMART' criteria were used to evaluate the feasibility of the alternatives to bedside of handover. The tape recorded handover would require a tape recorder being taken around to each of the patients and the interaction recorded. An informal discussion with the patients revealed that this method was distractive and the majority of them did not feel comfortable about their conversation being recorded. With regards to the computer generated handover using information technology, the patients felt this system will not enable them to engage fully in the process. It was also felt that since the first two options required extra financial, technical resources for implementation, these would not be feasible in the first instance whereas the bedside handover gained unanimous support from both patients and staff. This was also more realistic in term of its applicability in our practice area. It was specific, measurable in terms of its performance and achievable within existing resources and a defined time frame. Its foundation rested on evidence base practice, which showed theoretical soundness.

Selecting the change

There was a shared vision about the worth of the proposed change by the team and consequently bedside handover was logically considered as the best option for change. The vision formulated was that in three months' time, bedside handover would become the normal shift handover process of the ward. The mission statement agreed was "all handovers would be carried out at the patients' bedside between the incoming and outgoing nursing staff with the patients' involvement."

Force-field analysis

A force field analysis, as shown in table 1 was carried out to evaluate the driving and the restraining forces for the change as per Lewin's model [ 9 ]. The driving forces resided in the support of the ward manager, peers, evidence based arguments and our determination to see the change happen. The restraining forces were mostly related to a lack of information and uncertainty surrounding the change process. Other significant issues that were identified to cause resistance to the change were lateness at work, non-overlapping of shifts and maintaining confidentiality of patient's information.

Planning the change

Careful planning is essential if trauma is to be minimized [ 2 ]. It was quite important for us to provide information so as to unlock the status quo. This was done by drafting a protocol, (table 2 ) on a six points systematic step on how to proceed in practice with the change. This protocol was piloted over 2 morning and 2 evening handover sessions to ensure validity and reliability. There were no changes required to the protocol following the pilot study.

The time frame earmarked to implement the change was three months starting from the 8 th of February 2003 up to 8 th May 2003. One-month time was judged sufficient to unfreeze the situation and the remainder to implement and evaluate the change.

Selecting strategies for change

Choosing a strategy for the change process depended upon various factors and good interpersonal relationship was a critical factor. It has been proposed that strong leadership and excellent communication skills were essential if an atmosphere of trust was to be engendered [ 7 , 8 ]. With this in mind, the change was announced in advance to encourage the nurses. It also offered the opportunity to share the reaction of colleagues where some valuable proposals were proposed, for example, how to cater for lateness at work, non-overlapping of shift as well as dealing with confidentiality of information.

Confidential issues related to matters that the patients brought up during the admission procedure and during their stay, certain issues that were brought up during ward rounds and from the patients own requests.

In cases of occasional lateness in resuming work, the handover would proceed with the other patients in first the instance and if the staff was still late, then some other colleague would step in her place. Reassurance was given with respect to 'no substantial overlapping' of shift in that it would not have major bearing on the handover process by explaining that shorter handover can reduce the likelihood of information overload and result in concise and pertinent information being exchanged as per care plans. There was a general agreement that fifteen minutes as officially allocated for handover would be sufficient for this purpose. Assurance was also given that confidentiality of patients' clinical information would be taken into consideration in drafting a protocol for bedside handover, as shown in table 2 .

Empowering the staff

Several meetings were organized with different groups of nurses to explain and clarify any shortcomings and to reach a consensus. This approach was recommended by Driscol [ 4 ], as it empowers the team to make the change for itself, without instruction or oversight and is believed to be a strategy for an effective and lasting transformation in a team spirit. The empirical rational strategy was used to convince others of the veracity of the change by making reference to evidence base documentation on the positive outcomes that bedside handover might bring, for example, increase patient satisfaction. Nurses within the ring of informal leaders were gradually encouraged to take some of the ownership of the change by entrusting role model responsibilities to them. This proved to be quite successful as a strategy to encourage participation to create attitudinal and behavioral change. Eventually, there was more acceptance and collaboration on the part of the team to implement the change. In keeping with Skinner's theory [ 13 ], positive reinforcement, was used to praise and encourage staff. The ward manager helped in the reinforcement process by complimenting the whole team for their excellent effort to bring the change during the weekly meeting of staff. The strategy of facilitation also involved providing training in the new skill demanded by the change. Mocked handover exercises were demonstrated with the different steps of bedside handover to different groups of nurses. This was done by adopting a democratic leadership style engendering a participative approach, which in turn generated a degree of enthusiasm for the change.

Moving stage

Following a pilot handover session involving senior staff in a participant and an observer capacity over 2 morning and 2 evening handover sessions, which did not require any major changes, implementation of the bedside handover was started on 8 th of March 2003. For the first week, six senior staff who had experience in this area volunteered and took turn to continue to be present in as many handovers as observers and participants, to monitor and reinforce the established protocol step by step.

They also provided clarification and support to staff in cases of difficulty, and helped evaluate the extent of change that had taken place in an effective manner. The nurses present during the handover had no difficulty in adapting to this new situation, using a care plan incorporating a more psychosocial and patient-centered approach to bedside handover with the patients' participation.

Evaluation of the change

The evaluation of the implementation of bedside handover was carried out in two distinct phases. A protocol, as shown in table 2 , was developed which included 6 criteria was duly filled after every shift handover. As a benchmark, a good handover was one where at least five of the criteria were strictly followed. The data collection consisted of ten non-participant observation handovers. Semi-structured interviews, using a questionnaire derived from a focus group of staff and patients as shown in table 3 , with 40 patients were carried out to get their perceptions of the new handover. This was done randomly, consisting of both morning and evening handovers over a period of a week by a staff specifically chosen for this job from another ward to prevent bias from the hawthorn effects and ensure validity.

Analysis of results of the observational data on 10 handovers, Table 2 , showed that the first 5 criteria were met at 100% and the 6 th criteria at 90%. In one of the sessions, the nurse had left the patient whilst the bedside handover was in progress to attend to another patient without explaining the reason for this short absence to him which accounts for the 90%.

Analysis of the results of semi-structured interviews with 40 patients, Table 3 , show that a 96% overall satisfaction level was achieved. This was beyond our expectations, as we had targeted a success rate to be 80% initially. We had to be cautious about the result for it could be either most of the staff had accepted the change or just doing it in this euphoric phase.

Refreezing phase

The result was evaluated at a full staff meeting and the ward manager and colleagues recognized the change. Despite unlearning of the old practice had taken place two nurses still displayed some difficulties with the new handover as they were always eager to report everything themselves rather than allowing the patients to have a say. After a reassessment of the situation, accurate feedback was given to them. With the group support, they became used to the new system by observing their colleagues in action during the handover and doing it in turn. After a couple of sessions they became fully conversant with the new system. By this time, this project was ready for the refreezing stage.

One of the major difficulties encountered was to rally everybody behind this project. The normative re-education, in line Bernhard and Walsh [ 1 ], was used in order to help nurses value the new knowledge and create a readiness for learning. Various tasks identified for the future, for example on how to deal with issues of confidentiality, patients who would keep talking endlessly making the process drag on for a long time were allocated to members of the team according to their expertise to prepare so that they could be discussed in depth during the next meeting. A flexible and humanistic in approach was adopted in dealing with conflict, and resistance was not underestimated. Suggestions were treated with respect and dignity. Considerable effort was made to maintain good interpersonal relationship and to highlight motivating factors and safety needs. Constructive feedback was provided on their level of performance. Positive behaviors were rewarded equally in terms of recognition and praise and often with a simple and genuine "thank you". Application of this knowledge was reinforced from day one when this new handover became operational into the practice area through continuous coaching, supervision and mentorship.

Managing change in a hospital set up is a daunting task as it involves a change in the attitude and behavior of staff in a complex environment in order to gain their collaboration. The concept of no pain no gain was very evident throughout the process. Lewin's 3 – stage model was useful in implementing the change in a planned and structured way. Resistance was overcome by creating a climate which encouraged open communication. The support of the ward manager and key stakeholders were significant. Evaluation has shown that the new system of handover is working well but monitoring will be ongoing with evaluation of a larger sample of patients. This change has been an enriching experience for the staff, and has generated enthusiasm and given them confidence to question some of the practices on the ward. This new approach to handover can therefore be implemented in other areas of practice and evaluated to ensure that they are meeting patients' satisfaction. Further studies can be undertaken to explore how the multidisciplinary team could further consolidate this process.

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The authors are grateful to all the staff and patients who participated in this project

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Department of Health and Medical Sciences and Management, University of Mauritius, Reduit, Mauritius

Hemant K Kassean

Department of Health and Medical Sciences, University of Mauritius, Reduit, Mauritius

Zaheda B Jagoo

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Authors' contributions

HKK taught this module and supervised this change management project. ZBJ implemented this change in the gynaecological ward as part of her assessment in the "Management Development" module. Both authors wrote this manuscript, read and approved the final version.

Hemant K Kassean and Zaheda B Jagoo contributed equally to this work.

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Kassean, H.K., Jagoo, Z.B. Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius. BMC Nurs 4 , 1 (2005).

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Relationship between Nurses’ Attitudes and Satisfaction with Bedside Shift Reports and Patient Safety Culture

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nursing handover dissertation

Background: A thoroughly standardized nurse bedside shift report, including effective communication, may improve nurses’ satisfaction and patients’ safety. However, a few studies were found that measure the relationships between nurses’ attitudes and satisfaction with bedside shift reports and patient safety outcomes.

Purpose: This study aimed to measure nurses’ attitudes and satisfaction with bedside shift reports and their relationships with patient safety culture.

Methods: A cross-sectional and descriptive study was conducted between May to August 2021 among 90 bedside nurses conveniently recruited from a public hospital in Lebanon. The Bedside Handover Report Staff Nurses’ Satisfaction Survey and the Survey on Patient Safety (SOPS) were used to collect data. Data were analyzed using descriptive statistics such as mean and standard deviation and inferential statistics, i.e., Pearson correlation coefficient.

Results: The results showed that satisfaction scores were high in all the questions in the bedside shift reporting. The participants showed relatively positive attitudes towards bedside shift reports where all the statements recorded above-average mean values. The highest-ranking statement “bedside shift report is completed in a reasonable time” was recorded with a mean value of 3.35 (SD=0.87), while the lowest-ranking statement was “bedside shift report is relatively stress-free” with a mean value of 2.03 (SD=0.86). There were significant relationships between nurses’ satisfaction with shift reports and some patient safety culture composites, such as between nurses’ satisfaction with bedside shift reports and communication about errors and reporting of patient safety events ( p <0.05) and between nurses’ attitudes toward bedside shift reports and communication about errors ( p <0.001)

Conclusion: Implementation of the bedside shift report improves nurses’ levels of satisfaction, enhances positive attitudes toward work, and enhances patients' safety. Nursing leaders should encourage nurses to implement bedside handover reports in their hospitals.

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  • Whitty, J. A., Spinks, J., Bucknall, T., Tobiano, G., & Chaboyer, W. (2017). Patient and nurse preferences for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment. Health Expectations, 20(4), 742-750

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  • Afr J Paediatr Surg
  • v.20(3); Jul-Sep 2023
  • PMC10450103

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Improving Patient Handover: A Narrative Review

Zahra khalaf.

Department of Postgraduate Surgical Studies, Royal College of Surgeons in Ireland, Dublin, Ireland


The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients’ safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective.

MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review.

A number of handover interventions were explored. One intervention was changing the handover location to patients’ bedside; Bradley et al . found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al . associated with reductions in adverse events. Moreover, Lee et al . used simulation-based education and found that it significantly improved nurses’ knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al . implemented a mixture of interventions and found that they improved patient safety and reduced adverse events.


The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive.


Clinical handover entails communicating information about patient care from one health-care professional to another. It may be used in the context of a shift change, the transfer of patient care to another physician or health service organization, or the referral, admission, or discharge. Handover involves the transfer of the responsibility and accountability of care for a patient temporarily or permanently.[ 1 ] The handover process has been directly associated with patient safety. Moreover, suboptimal communication during the process leads to poor patient outcomes due to inaccurate knowledge of the patient’s clinical status, which subsequently results in delayed investigations and treatments as well as medical errors and an increased burden on the health-care system.[ 2 ] Improving patient handover can improve patients’ safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective.

Study design

The Best Evidence Medical Education review guidelines were used to conduct this literature review.

Search strategy

MEDLINE (EBSCO) was searched for interventions that impact the efficacy of clinical handovers. The search terms combined the handovers with the terms “tools” or “interventions” or “factors” or “optimizing” or “effectiveness” or “effective” [ Table 1 details full search terms and limiters]. In total, 1087 publications were retrieved. Studies were sorted according to their relevance to the topic. The eligibility of the articles was determined by reading through the titles and abstracts followed by full texts.

Inclusion and exclusion criteria

Articles addressing interventions aimed at improving the effectiveness of clinical handovers were included in the study. Studies were excluded if they deviated from the topic, were not published in peer-reviewed journals, were not published in English, or were based on animal studies.

Data extraction

After irrelevant articles were excluded, the remaining articles’ titles and abstracts were read to ensure they were relevant to the studied topic. Moreover, reference searching of the selected articles was conducted to find other relevant articles that may have been missed in the original search. Then, the full texts of the first 11 articles, sorted in order of relevance, were read to determine their relevance to the topic and derive the factors influencing handover in clinical settings. From these, two articles were included and nine were excluded from the study. The remaining four articles were identified through reference searching the selected articles. The nine articles were excluded due to their lack of relevance to the review.

Six studies were selected for this literature review. Different handover interventions were implemented by the selected studies [The interventions used by each study are outlined in Table 2 and The types of data collected and frameworks followed by all of the studies are detailed in Table 3 ].

Interventions used to improve clinical handover

Frameworks used or data management plan used by the studies

TCAB: Transforming care at the bedside, SABR: Background-assessment-recommendation, OMRU: Ottawa model of research use, ADDIE: Analysis, design, development, implementation, and evaluation

Changing the location of handovers to patients’ bedside

One modification that has been incorporated to improve handovers is changing the location where they take place to the bedside. Bradley et al . individually examined the effect of changing the handover approach from a closed-door handover to a bedside handover. The assessed outcomes were nursing satisfaction, the duration of handovers, and the incidence of adverse incidents. The authors found that the change in setting to the bedside resulted in a decrease in the time taken to hand over patients and a significant reduction in the occurrence of incidents such as patient falls and medication errors. In fact, the incidence of falls decreased from one to two falls in a month to one fall in 6 months. Hence, the authors deduced that this intervention had made handovers more effective and increased patient safety.[ 4 ]

Educating health-care professionals about handovers

Another intervention aiming to increase the efficacy of handovers is educating health-care professionals about how handovers should be conducted. Hada et al . and Sand-Jecklin and Sherman explored such interventions, whereby they provided nursing staff with an educational package emphasizing the “situation-background-assessment-recommendation (SBAR)” handover tool. The package was composed of video examples and written material outlining the SBAR handover format.[ 5 , 8 ] Hada et al . found that educating nursing staff about handovers improved patients’ and nurses’ satisfaction with the handover process ( P < 0.05). Moreover, although they found that education resulted in a reduction in patient adverse events, with falls, pressure injuries, and medication errors decreasing by 9.7%, 75%, and 11%, respectively, these reductions were not statistically significant ( P > 0.05). However, this lack of significance may be attributed to the small sample size, with only 58 patients included, which may not have been enough to establish statistical significance.[ 5 ] Meanwhile, Sand-Jecklin’s and Sherman’s results demonstrated a 35% decrease in the number of falls and a 50% decrease in the incidence of medication errors. Individually, the reduction of falls and medication errors was also not statistically significant ( P > 0.05). However, the overall decline in the occurrence of adverse events was clinically significant.[ 8 ]

Using a simulation-based education program on handovers

Furthermore, the use of simulation-based education programs is another intervention that has been used to improve clinical handovers. Lee et al . studied this intervention to determine whether it improved the efficacy of patient handovers. This study’s intervention took place in the following stages: a prebriefing of the scenario, putting the participants through the simulated scenario, a debriefing and reflection stage when nurses were also advised on how to improve their handovers, and an application stage. The authors found that nurses’ knowledge, performance competence, and self-efficacy significantly improved following the program. Therefore, the simulation program was effective in improving the handover experience.[ 6 ]

Using transforming care at the bedside improvement strategies

Moreover, the 13 transforming care at the bedside (TCAB) strategies are a framework which aims to involve staff and managers in applying different strategies which aim to improve patient safety. These strategies are composed of four pillars: “safety and reliability, care team vitality, patient centeredness, and increasing value.”[ 7 ] Chaboyer et al . aimed to assess the effects of implementing the TCAB strategies to reduce the incidence of adverse events and enhance patient safety. Handover improvements were emphasized as part of patient centeredness and they included bedside handovers, daily goals for each patient written on a whiteboard at their bedside, and discharge checklists. However, as other changes related to the other pillars of the TCAB strategies were implemented simultaneously, the findings could not be attributed solely to the handover modifications. Overall, implementing the TCAB strategies resulted in reduced occurrences of medication errors, patient falls, and pressure ulcers, which indicated improvements in patient safety. There was an absolute reduction of medication errors by approximately one half.[ 7 ]

Combining a group of interventions

While interventions to improve handovers may be applied individually, it is also possible to implement a group of interventions simultaneously. Hada et al . implemented the “bundle of interventions” approach. They followed the Ottawa Model of Research Use (OMRU), which is composed of three phases: preimplementation, implementation, and evaluation.[ 3 ] During the preimplementation phase, they identified factors which impede and facilitate handovers;[ 3 ] this information was derived from a pilot study by Hada et al . which identified the barriers and facilitators of effective handovers according to the perceptions of nursing staff.[ 9 ] The barriers highlighted were inconsistent frameworks, a lack of patient inclusion, time constraints, and environmental obstacles. Meanwhile, facilitators of efficient handovers were thought to be documenting information in integrated electronic medical records, setting leaders who outline their expectations and support staff members, and providing education on how to conduct handovers.[ 9 ] Meanwhile, during the implementation phase, a number of interventions centered around the “Identify, Situation, Background, Assessment, Recommendation (ISBAR)” framework were applied. The interventions included the use of an integrated electronic medical record, role modeling by senior nurses, a briefing at the nursing station about patients’ sensitive information, and the provision of education about handovers. Furthermore, during the evaluation phase, the implications of the interventions applied on patient safety were assessed. The authors found that nursing compliance with handovers had improved. Moreover, patient safety was enhanced, as reflected by reductions in falls, pressure injuries, and medication errors.[ 3 ]


Handovers are forms of communication during which the accountability and responsibility of a patient shift from one health-care professional to another. The impact of patient handovers on patient safety is well established.[ 2 ] This has led organizations such as the Australian Commission for Safety and Quality in Health Care (ACSQHC) to prioritize handovers and develop initiatives to provide guidance and help improve clinical handovers.[ 1 ] The ACSQHC recommends having a standardized and structured clinical handover process; this entails concisely transferring information, outlining the purpose of the handover, using a structured communication tool (such as the ISBAR), and explaining the nature of the transfer of responsibility and accountability.[ 1 ]

Communicating during handovers is a complex process that is subject to variability due to differences in situations, communication modalities, sites of handovers, and the involvement of different disciplines. Handovers are indicated in situations where there is a need for the transfer of care; this may be due to a need to transfer care to another health-care professional, department, or health organization or when a patient is temporarily transferred for investigations or appointments, or when a patient is discharged. The handover may be communicated using different methods such as face-to-face interactions, phone communications, and orders written physically or on an electronic integrated system. Moreover, the locations where handovers can take place can vary; they may occur in common staff areas, at the clinic or ward’s reception, or at the patient’s bedside.

In addition, different health-care professionals may be involved, and they can be from different organizations or disciplines. Therefore, this explains the need for the structure and standardization emphasized by the ACSQHC.[ 1 ] This review highlights improvements in patient outcomes in two studies[ 5 , 8 ] following the education of health-care staff using the ISBAR communication framework.

Furthermore, an important dimension of clinical handovers is ensuring the transfer of correct and accurate information. To ensure accuracy, the handover must be prepared in advance, and the person handing it over must possess adequate relevant information while also taking the patient’s concerns and wishes into consideration. Involving patients in the handover process can allow them to express their perspectives and concerns, which can result in improved patient outcomes and fewer adverse events and readmissions.[ 10 ] This is congruent with Bradley’s and Mott’s finding of a decrease in the incidence of adverse events and improved patient outcomes following moving the location of handovers to the patient’s bedside.[ 4 ]


This review is limited by the use of a single database, MEDLINE (EBSCO), to search for eligible studies, which may have led to the omission of important articles within the literature. Moreover, only a small number of articles were selected. In addition, variations in study designs and assessment tools may have played a role in the differences between reported outcomes across different studies. Furthermore, differences in populations and population sizes may also have made the comparison difficult. Finally, the interventions used by the selected studies were all applied to nursing handovers, which limits their generalizability to handovers between other health-care professionals due to the differences in the nature of their jobs.


This review provides a preliminary outline of the effect of different interventions on the efficacy of handovers. At least one study was included to assess each intervention, which included changing the location of patient handovers to the bedside, providing education as well as simulation-based education on how to conduct handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All studies demonstrated improved patient outcomes and a reduction in adverse events (falls, pressure ulcers, and medication errors) following the implementation of the different interventions, although in some cases the improvements were not statistically significant. However, due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive. Further well-designed studies need to be conducted to establish robust evidence on the efficacy of the different interventions aimed at improving clinical handovers. Moreover, interventions aimed at improving clinical handovers should be applied to other health-care professionals, such as doctors.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.


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Kang, Evelyn P. "The Development and Feasibility Testing of a Patient-Centred Discharge Education Intervention to Improve the Postoperative Recovery of General Surgery Patients." Thesis, Griffith University, 2022.

Sammut, Alexei. "Maltese nurses' and midwives' attitudes towards mental illness : a national comparative study." Thesis, Kingston University, 2017.

Sehume, Gloria Gaogakwe. "Ethical decision-making the experience of nurses in selected clinical settings /." Diss., Pretoria :b [s.n.], 2008.

Veeramah, Rangasamy Ven. "Utilisation of research findings by graduate nurses and midwives and their attitude towards research." Thesis, University of Greenwich, 2007.

Macdonald, Danielle. "Exploring Collaboration Between Midwives and Nurses in Nova Scotia: A Feminist Poststructuralist Case Study." Thesis, Université d'Ottawa / University of Ottawa, 2019.

Buhlmann, Melanie. "Moving on after critical incidents in health care. Second victims: A qualitative study of the experiences of nurses and midwives." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2019.

Crona, Malin, and Johanna Bengtsson. "Barnmorskor och undersköterskors behov av stöd vid möten med föräldrar som föder barn som inte lever : En kvalitativ intervjustudie med fokusgrupper." Thesis, Högskolan Dalarna, Sexuell, reproduktiv och perinatal hälsa, 2017.

Yimer, Endris Mekonnen, Firew Ayalew Desta, Kefyalew Muleta Akassa, Tadele Bogale Yitaferu, Mesfin Goji Abebe, Mebit Kebede Tariku, and Hannah Gibson. "Assessment of Midwifery and Nursing Students’ Nutrition Competence in Ethiopia: A Cross Sectional Study." Digital Commons @ East Tennessee State University, 2017.

Halldin, Anna, and Cecilia Hjalmarsson. "Faktorer av betydelse för säker överrapportering mellan personal inom ambulanssjukvård och akutmottagning : en litteraturstudie." Thesis, Sophiahemmet Högskola, 2020.

Hansson, Elina, and Amanda Vikström. "Delaktighet och säkerhet vid bedsiderapportering : Patientens och sjuksköterskans upplevelse." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019.

Forrester, Kim, and n/a. "The Impact of Structural (Legislation and Policy), Professional and Process Factors on the Outcomes of Disciplinary Tribunals and Committees in Cases of Sexual Misconduct and Incompetent or Unsafe Practice." Griffith University. School of Nursing, 2004.

Forrester, Kim. "The Impact of Structural (Legislation and Policy), Professional and Process Factors on the Outcomes of Disciplinary Tribunals and Committees in Cases of Sexual Misconduct and Incompetent or Unsafe Practice." Thesis, Griffith University, 2004.

Johnson, Erin Johnson. ""Strong Passions of the Mind": Representations of Emotions and Women's Reproductive Bodies in Seventeenth-Century England." Miami University / OhioLINK, 2018.

Söderpalm, Emma, and Matilda Öreberg. "Patienters och sjuksköterskors upplevelser av bedsiderapportering : En systematisk litteraturöversikt." Thesis, Malmö universitet, Malmö högskola, Institutionen för vårdvetenskap (VV), 2021.

Arvidsson, Jennie, and Emelie Selström. "Anestesi- och intensivvårdssjuksköterskors upplevelser av överrapportering av postoperativa patienter." Thesis, Luleå tekniska universitet, Omvårdnad, 2018.

Johansson, Isabelle, and Linn Westin. "Att vårda kvinnor i samband med inducerad abort - Barnmorskors och sjuksköterskors erfarenheter : En kvalitativ metasyntes." Thesis, Högskolan Dalarna, Sexuell, reproduktiv och perinatal hälsa, 2018.

Kaufrinder, Anthony Pierre. "Registered nurses' handover practices in emergency care units." Thesis, 2011.

Lengu, Edoly Shirley. "The quality of professional practice by registered nurses and midwives in central hospitals in Malawi." Diss., 2011.

Michaud-Hamilton, Nicole. "Developing a Standardized Electronic Reporting System for Visiting Nurses." Thesis, 2014.

Victor, Vonette J., and 費奈特. "To Explore Sexual Self Concept among Midwives, Registered Nurses and Nursing Students in St. Lucia." Thesis, 2014.

"A continuing professional development system for nurses and midwives in South Africa." Thesis, 2008.

Harrowing, Jean Norma. "The impact of HIV education on nurses and nurse-midwives in Uganda." Phd thesis, 2009.

Ng'ang'a, Njoki. "Manager and Provider Perspectives of the Work Environment Experienced by Associate Clinicians, Nurses and Midwives Who Deliver Emergency Obstetric Care in Tanzania." Thesis, 2013.

Walpole, Lynette Mary. "Understanding stress and burnout in birth suite midwives." Thesis, 2011.

Lebese, Moipone Veronicah. "A phenomenological study of the experiences of nurses directly involved with termination of pregnancies in the Limpopo Province." Diss., 2009.


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