This study was two-fold in nature. Initially, it examined the information environment and the use of customary information tools to support medical handovers in a large metropolitan teaching hospital on four weekends (i.e. Friday night to Monday morning). Weekend medical handovers were found to involve sequences of handovers where patients were discussed at the discretion of the doctor handing over; no reliable discussion of all patients of concern occurred at any one handover, with few information tools being used; and after a set of weekend handovers, there was no complete picture on a Monday morning without an analysis of all patient progress notes. In a subsequent case study, three information tools specifically designed as intervention that attempted to enrich the information environment were evaluated. Results indicate that these tools did support greater continuity in who was discussed but not in what was discussed at handover. After the intervention, if a doctor discussed a patient at handover, that patient was more likely to be discussed at subsequent handovers. However, the picture at Monday morning remained fragmentary. The results are discussed in terms of the complexities inherent in the handover process
BeharaR.WearsR.L.PerryS.J.EisenbergE.MurphyL.vanderHoeffM.ShapiroM.BeachC.CroskerryP.CosbyK. (2005). A conceptual framework for studying the safety of transitions in emergency care. In: Advances in patient safety: From research to implementation AHRQ Publication Nos. 050021 (1–4), Agency for Healthcare Research and Quality, Rockville, MD, Vol. 2. Available at: http://www.ahrq.gov/qual/advances/ (accessed 20 January 2008).
3.
BrandwijkM.NemethC.O'ConnorM.KahanaM.CookR.I. (2003). Distributing cognition: ICU handoffs conform to Grice's maxims. Poster, University of Chicago. Available at: http://www.ctlab.org/documents/SCCMPoster1.27.03.pdf (accessed 20 January 2008).
4.
BrennanT.A.ZinnerM.J. (2003). Residents' work hours: A wake up call?International Journal of Quality in Health Care15(2): 107–108. Available at: http://intqhc.oupjournals.org/cgi/reprint/15/2/107 (accessed 20 January 2008).
5.
CharapM. (2004). Reducing resident work hours: Unproven assumptions and unforeseen outcomes. Annals of Internal Medicine140(10): 814–815. Available at: http://www.annals.org/cgi/reprint/140/10/814.pdf (accessed 20 January 2008).
6.
HopkinsonJ.B. (2002). The hidden benefit: The supportive function of the nursing handover for qualified nurses caring for dying people in hospital. Journal of Clinical Nursing11(2): 168–175.
LaineC.GoldmanL.SoukupJ. R.HayesJ. G. (1993). The impact of a regulation restricting medical house staff working hours on the quality of patient care. Journal of the American Medical Society269(3): 374–8.
9.
LallyS. (1999). An investigation into the functions of nurses' communication at the inter-shift handover. Journal of Nursing Management7(1): 29–36.
10.
LeeL.H.LevineJ.A.SchultzH.J. (1996). Utility of a standardized sign-out card for new medical interns. Journal of General Internal Medicine11(12): 753–5.
11.
MooreC.WisniveskyJ.WilliamsS.McGinnT. (2003). Medical errors related to discontinuity of care from an inpatient to an outpatient setting. Journal of General Internal Medicine18(8): 646–651. doi:10.1046/j.1525–1497.2003.20722.x. Available at: http://www.ingentaconnect.com/content/bsc/jgi/2003/00000018/00000008/art00008 (accessed 20 January 2008).
12.
National Expert Advisory Group on Safety and Quality in Australian Health Care. (1998). Commitment to quality enhancement: The interim report of the National Expert Group on Safety and Quality in Australian Health Care. Canberra, ACT, Commonwealth of Australia.
13.
PattersonE.S.WoodsD.D. (2001). Shift changes, updates, and the on-call architecture in space shuttle mission control. Computer Supported Cooperative Work10(3–4): 317–346.
14.
PattersonE.S.RothE.M.WoodsD.D.ChowR.GomesJ.O. (2004). Handoff strategies in settings with high consequences for failure: Lessons for health care operations. International Journal for Quality in Health Care16(2): 125–132.
15.
PerryS.J. (2004). Transitions in care: Studying safety in emergency department signovers. NPSF Newsletter. Focus On Patient Safety7(2): 1–3. Available at: http://www.npsf.org/download/Focus2004Vol7No2.pdf (accessed 20 January 2008).
16.
PerryS. J.WearsR. L.EisenbergE.MurphyL.ShapiroM.BeachC.CroskerryP.BeharaR.VanderhoefM.WearsS. (2005). Transitions in care: Signovers in the emergency department. Proceedings of the International Conference on Healthcare Systems Ergonomics And Patient Safety (HEPS), Florence, Italy, March/April 2005, pp. 220–223.
17.
PetersenL.A.BrennanT.A.O'NeilA.C.CookE.F.LeeT.H. (1994). Does housestaff discontinuity of care increase the risk for preventable adverse events?Annals of Internal Medicine121(11): 866–872. Available at: http://www.annals.org/cgi/content/full/121/11/866.
18.
PetersenL.A.OravE.J.TeichJ.M.O'NeilA.C.BrennanT.A. (1998). Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Joint Commission Journal on Quality Improvement24: 77–87.
19.
RoughtonV.J.SeversM.P. (1996). The junior doctor handover: Current practices and future expectations. Journal of the Royal College of Physicians of London30(3): 213–4.
20.
SextonA.ChanC.ElliottM.StuartJ.JayasuriyaR.CrookesP. (2004). Nursing handovers: Do we really need them?Journal of Nursing Management12(1): 37–42.
21.
ThakoreS.MorrisonW. (2001). A survey of the perceived quality of patient handover by ambulance staff in the resuscitation room. Emergency Medicine Journal18: 293–296.
22.
Van EatonE.G.HorvathK.D.LoberW.B.PellegriniC.A. (2004). Organizing the transfer of patient care information: The development of a computerized resident sign-out system. Surgery136(1): 5–13.
23.
WachterR.M. (2004). Handoffs and fumbles. In: Internal Bleeding: The truth behind America's terrifying epidemic of medical mistakes. WachterR.M.ShojaniaK. (eds). New York, Rugged Land: 159–180.
24.
WattersD.AmottD.SelvidgeJ.KakrisP.PapasC. (2004). Electronic medical handover: Towards safer medical care. Proceedings of the Health Informatics Conference (HIC). Brisbane, Australia.
25.
WearsR.L.PerryS.J.ShapiroM.BeachC.CroskerryP.BeharaR. (2003). Shift changes among emergency physicians: Best of times, worst of times. Proceedings of the Human Factors and Ergonomics Society 47th Annual Meeting, Denver, CO: Human Factors and Ergonomics Society, pp. 1420–1423.
26.
WilsonS.GalliersJ.FoneJ. (2005). Medical handover: A study and implications for information technology. Proceedings of the International Conference on Healthcare Systems Ergonomics and Patient Safety (HEPS), Florence, Italy, March/April 2005, pp. 333–336.
