Background: Ineffective clinical handover has the potential to compromise patient safety and quality of care. Standardizing the handover process is a widely adopted improvement strategy intended to reduce failures of information transfer. By enabling real-time access to patient information, electronic medical records (EMRs) could address communication issues inherent to nursing handover.
Objective: This case study sought to compare the quality of nursing handover occurring at EMR-enabled sites with that occurring at paper-based sites, within a single Australian public health service.
Methods: A comparative case study design was used, using quantitative data collected from observational audits of 60 handovers and posthandover surveys conducted in EMR-enabled and paper-based ward environments. Handover quality was measured through compliance with the organization's Clinical Handover Standard and staff-reported perceptions, enabling comparison between cohorts.
Results: Compared with paper-based wards, EMR-enabled wards demonstrated more consistent communication of clinical alerts and risks and fewer interruptions, whereas paper-based wards showed higher rates of bedside handover and patient engagement.
Conclusions: EMR implementation alone does not ensure high-quality nursing handover. EMR interface design and functionality may act as a barrier to bedside handover and patient engagement, and contribute to continued reliance on paper-based artifacts. Targeted EMR design and nursing informatics-led optimization are required to better support nursing handover as a complex and cognitively challenging communication process.
Keywords: electronic health record; electronic medical record; health information systems; nursing handover; patient engagement.
© Lisa Browning, Urooj Raza Khan, Sandra Leggat, Nicholas Monypenny, James H Boyd. Originally published in JMIR Nursing (https://nursing.jmir.org).