Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient

Emerg Med Australas. 2013 Oct;25(5):393-405. doi: 10.1111/1742-6723.12120. Epub 2013 Sep 18.


Clinical communication and recognising and responding to a deteriorating patient are key current patient safety issues in healthcare. The aim of this literature review is to identify themes associated with aspects of the hospital clinical handover between paramedics and ED staff that can be improved, with a specific focus on the transfer of care of a deteriorating patient. Extensive searches of scholarly literature were conducted using the main medical and nursing electronic databases, including Cumulative Index to Nursing and Allied Health Literature, Medline and PubMed, during 2011 and again in July 2012. Seventeen peer-reviewed English-language original quantitative and qualitative studies from 2001 to 2012 were selected and critically appraised using an evaluation tool based on published instruments. Relevant themes identified were: professional relationships, respect and barriers to communication; multiple or repeated handovers; identification of staff in the ED; significance of vital signs; need for a structured handover tool; documentation and other communication methods and education and training to improve handovers. The issues raised in the literature included the need to: produce more complete and concise handovers, create respectful and effective communication, and identify staff in the ED. A structured handover tool such as ISBAR (a mnemonic covering Introduction, Situation, Background, Assessment and Recommendations) would appear to provide a solution to many of these issues. The recording of vital signs and transfer of these data might be improved with better observation systems incorporating early warning strategies. More effective teamwork could be achieved with further clinical communications training.

Keywords: ambulance; deteriorating patient; emergency department; handover; paramedic.

Publication types

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

MeSH terms

  • Allied Health Personnel / organization & administration*
  • Clinical Protocols
  • Communication
  • Continuity of Patient Care / standards
  • Disease Progression
  • Emergency Service, Hospital / organization & administration*
  • Humans
  • Patient Handoff / organization & administration
  • Patient Handoff / standards*