The unappreciated challenges of between-unit handoffs: negotiating and coordinating across boundaries

Ann Emerg Med. 2013 Feb;61(2):155-60. doi: 10.1016/j.annemergmed.2012.04.009. Epub 2012 May 5.


Although interest in studying and improving handoffs has grown considerably in recent years, a general tendency to treat handoff as a single type of activity has resulted in overlooking important variation and in understudying one consequential type: between-unit handoffs. Using the admission handoff between emergency departments and inpatient services as an example, this conceptual article identifies 2 distinguishing structural features of between-unit transitions and demonstrate how these features create negotiation and coordination challenges that are further complicated by several contextual factors. Between-unit handoffs are distinguished from within-unit handoffs because the former are triggered by patient conditions as opposed to shift schedules and entail working across organizational boundaries rather than within them. Consequently, between-unit handoffs are challenged by several contextual factors, including interprofessional differences, unequal distributions of power among units, frequent lack of established relationships among the involved parties, infrequent face-to-face communication, a lack of awareness of the other unit's state, and the fact that responsibility and control of patients are transferred separately. Implications for improvement are discussed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Communication
  • Continuity of Patient Care / organization & administration
  • Humans
  • Interinstitutional Relations
  • International Cooperation*
  • Negotiating
  • Patient Transfer* / methods
  • Patient Transfer* / organization & administration