• M Sujan, P T Chessum, M Inada Kim, and P Spurgeon.
• Health Sciences, Warwick Medical School, Coventry, United Kingdom.
• Emerg Med J. 2013 Oct 1;30(10):873.

Objectives & BackgroundHandover in emergency care is an important patient safety issue and has particular problems due to different environmental, professional, organisational and cultural backgrounds. Previous work as focussed on the standardisation of handover content (including use of checklists), relatively little is known about the verbal behaviours that shape handover conversations. This study looks at both the content of the handover and the verbal behaviours during different types of handovers around the emergency department.MethodsThree handovers were studied: ambulance service to ED in 'Resuscitation' and 'Majors' areas and referrals to acute medicine. They were audio recorded in three NHS emergency departments. Handover conversations were segmented into utterances. Frequency counts for content and language forms were derived for each type of handover using Discourse Analysis. Verbal behaviours were identified using Conversation Analysis.Results203 handover conversations were analysed. Handover conversations involving ambulance services were mainly descriptive (60%-65% of utterances), unidirectional and focused on patient's clinical presentation (75%-80%). Referrals entailed more bidirectional conversation focused on the decision to admit and immediate care needs. Across all types of handover, only 1.5%-5% of handover conversation content related to the patient's social and psychological status and needs.ConclusionHandover may entail both descriptive (aimed at information transfer) and collaborative (aimed at joint decision-making) elements. Standardisation of handover needs to accommodate collaborative aspects with their greater variability according to the individual situation, and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity.

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