Communication, Handoff, Handover, Nursing, Standardized tool, Systematic review



  1. Galatzan, Benjamin J. MSN, RN
  2. Carrington, Jane M. PhD, RN, FAAN


Miscommunication that occurs during the exchange of information between healthcare providers accounts for approximately 80% of adverse events in the healthcare setting. Nurses devote 10% to 15% of the workday to the nurse-to-nurse hand-off communication. The hand-off itself has remained virtually unchanged for the past 20 years, although the process is prone to errors. The introduction of the electronic health record and mandates to decrease errors and improve patient outcomes has led to an influx of research on the nurse-to-nurse hand-off communication. This article provides a comprehensive synopsis of the hand-off and the state of science on nurse-to-nurse communication using hand-offs. In general, the use and implementation of standardized tools and the nurse's perception of and satisfaction with the hand-off communication have been researched extensively. A standardized hand-off tool increases nurse satisfaction with the structure and consistency of the hand-off. While electronic health record-related forms and devices are not utilized by nurses, communication patterns and communication behaviors can also influence the effectiveness of the hand-off message. The areas of memory, cognition, and content of the hand-off affect the transfer and recall of hand-off information. Continued research on hand-off communication is essential to ensure patient safety.


Article Content

Approximately 80% of errors in healthcare are credited to miscommunications occurring during the transfer of care.1 The possible errors that occur as a result of miscommunication during the transfer of care are delayed diagnosis, delayed or omitted treatments including medications, and missed or repeated testing.2,3 The negative consequences of these errors for the patient are extended hospitalization, increased costs, and actual harm.2,4 The Joint Commission considers the improvement of healthcare provider communications and timely communication of patient information as National Patient Safety Goals.5 The transition of patient care has several different labels: hand-off, handover, patient rounding, and change-of-shift report. The transition of care for the purpose of this article will focus on the nurse-to-nurse hand-off communication.


The nurse-to-nurse hand-off communication is defined as the transfer of patient care and responsibility from one healthcare provider (eg, nurse, physician, or nurse practitioner) to another.6-8 The Joint Commission in 2006 issued a mandate calling for the development and implementation of a standardized hand-off template.9,10 In 2012, The Joint Commission released a suite of tools to assist with implementation.1 Currently, several templates have been implemented in various inpatient and outpatient settings with the intent to improve hand-off communication.2,11-23 Unfortunately, little is known as to patient outcomes as a result of the implementation and usage of standardized templates. We present the results of a comprehensive state of the science of nurse-to-nurse communication using hand-offs.



Transferring the responsibility of patient care from one nurse to another can occur multiple times per day. Additionally, 10% to 15% of the workday is devoted to nurse-to-nurse communication.24 The hand-off occurs at the change of shift, between nursing units (intradepartmental), interdepartmental (test, procedures, and therapies), and when the patient transfers from one healthcare facility to another. The nurse-to-nurse hand-off involves communicating patient data, information, and knowledge to ensure patient safety and continuity of care.21,25,26 The hand-off communication requires an extensive amount of cognitive awareness and functioning while nurses analyze and synthesize the information.8 The hand-off traditionally occurs in one of the following methods: taped, verbal at the bedside, or verbal not at the bedside.4,12,20,27 The hand-off also serves other functions such as socialization, team building, emotional support, and education (teaching and learning).28,29 The nurse-to-nurse hand-off communication is not formally taught in nursing education but is acquired through observation and on-the-job training. The format of the nursing hand-off has changed little over the past 20 years despite evidence of the process being susceptible to miscommunication.


Most adverse events affecting patient outcomes are the result of miscommunication rather than provider competency or skill.30 Two of the most influential healthcare organizations, The Joint Commission10 and the World Health Organization,30 have mandated the implementation of a standardized hand-off. These initiatives have led to the development and implementation of several standardized hand-off tools and checklists,29 including Situation Background Assessment Recommendation (SBAR), Illness severity Patient summary Action list Situation awareness and contingency planning Synthesis by receiver (I-PASS),9,23 Introduction Situation Background Assessment Recommendation (ISBAR); Name Unexpected outcomes Tubes Safety scan (NUTS); Record Evidence Enquire Discuss (REED);18 Presenting information Vital signs Input/output Treatment Admission or discharge criteria and Legal documents (P-VITAL); and Identification of the patient Clinical history/presentation Clinical status Care plan Outcomes and goals of care (ICCCO).31,32 As demonstrated by this list, no single method or approach has been recommended for widespread implementation. The nursing community has not been able to agree as to the structure or clinical content for a standardized hand-off.29,33


Nurse-to-nurse hand-off communication has been researched extensively and emphasized in the literature as an area of importance because of its role in patient safety. The standardized templates provide a structure for the hand-off but do not address content. Even with the increased emphasis on the hand-off communication, many questions are left unanswered. What is the current state of the science of nursing hand-offs? What does the research indicate as best practice? Where should nursing scientists focus future research on nurse-to-nurse hand-off communication?



A comprehensive literature review was conducted to identify relevant research studies addressing nurse-to-nurse handoff communication. The literature search was performed to identify studies undertaken from 2007 to 2017 utilizing the following online databases: CINAHL, PubMed, PsycINFO, MEDLINE, and Cochrane Library. The following search terms were used: "handoff," "handover," "communication," "nurse-to-nurse communication," and "nurse." An additional search was conducted to supplement the initial exploration, and the secondary search included the following terms: "cognition," "memory," "handoff," and "handover." The following inclusion criteria were applied: peer-reviewed articles in English, both quantitative and qualitative in nature, that were published within the identified 10-year span from 2007 to 2017. Additional inclusion criteria were a primary focus on nurse-to-nurse communication, cognition, and memory. Exclusion criteria were book reviews, non-English articles, letters to editors, books, commentaries, literature reviews, and abstracts for presentations. The initial search and the supplemental search resulted in 260 articles. The results were reviewed, and duplicates were eliminated. The remaining article abstracts were evaluated for retention based on relevance to the subject and the inclusion and exclusion criteria. A total of 30 articles were retained for evaluation. A comprehensive summary of the articles included in the systematic review is shown in Table 1.

Table 1 - Click to enlarge in new windowTable 1 Summary of the Nurse-to-Nurse Hand-off Communication


The systematic review was analyzed using thematic analysis methodology to identify themes or categories in the textual data.45 The following six themes were identified in the nurse-to-nurse hand-off communication systematic review of the research: standardized tools, nurses' perception of and satisfaction with the hand-off, communication and communication patterns, use of electronic tools, hand-off content, and cognition/memory. A majority of the articles (21 of the 30) focused on standardized hand-off tools and the nurses' perception of and satisfaction with the hand-off.


Standardized Hand-off Tools

A standardized hand-off tool, as defined by the literature, is a predetermined form that provides a structured sequence of information for the hand-off communication.6,13,15,16 The structured sequencing of information also provides consistency to the hand-off process. There are numerous structured models of hand-off tools that have undergone research, including REED, ISBAR, SBAR, and ICCCO.17,20,24,32 The advantages of implementing a standardized hand-off tool are decreased information overload, increased quality of the information exchanged,32 decreased risks to patient safety, and improved patient outcomes.16 Several factors must be considered before implementing a standardized hand-off tool for a nursing unit or medical institution, including current style, purpose, timing, and method of the hand-off.15,16,24,32,35 In addition, the culture of the unit and organization must also be assessed.20 A strategic plan that included the staff nurse's involvement in the development and implementation of a standardized hand-off protocol/tool increased the usage and satisfaction of the tool.2,13,16,35 Interestingly, the use of an educational intervention to promote and increase compliance with using the ISBAR model in one institution was not successful.17 The standardized hand-off tool must be flexible to meet the various needs of each nurse, nursing unit, healthcare environment, and patient situation.


One objective or outcome of implementation of a standardized hand-off is to improve patient outcomes by decreasing the risk to patient safety. Several studies indicated a reduction in the errors of omission,15 a decrease in medication errors,35 and an increase in patient and family involvement in the hand-off.24 Additional outcomes identified after implementation of a standardized tool were increased nurse satisfaction with the organization of the hand-off and the content of the nurse-to-nurse communication message.13,24 The research indicated an increase in overall nurse satisfaction with the hand-off process35 and a perceived increase in the effectiveness in nurse-to-nurse hand-off communication.20 None of the studies in this systematic review provided direct evidence of improved patient outcomes as a result of implementing a standardized nurse-to-nurse handoff communication tool.


Satisfaction With and Perceptions of the Hand-off

The literature has defined nurse perceptions of and satisfaction with the hand-off as the nurse's view, interpretation, and judgment of the hand-off communication.6,12,14,19,28,41 Nurses' perception of and satisfaction with the hand-off communication can influence the content, quality, efficiency, and effectiveness of transferring relevant and pertinent patient information. Several factors were identified by nurses as negatively influencing nurse-to-nurse hand-off communication. The absence of consistency and structure in nurse-to-nurse communication is associated with errors in the hand-off.4,6,11,37 Environmental distractions such as unit background noise, phone calls, and interruptions disrupted the flow of information during the hand-off.4,39,41 The time required and allotted for the hand-off was perceived as negatively influencing the process. The hand-off was time consuming,12,28,41 and insufficient time was permitted for the hand-off,28 which increased the risk of miscommunicating patient information. The hand-off often contained irrelevant and too much patient information12 or lacked essential patient information.4,28 All three factors contributed to miscommunication of pertinent information. Nurses reported that a significant indicator of the quality of the hand-off was the experience of the nurse giving and receiving the report.4,26 The more experience the nurse had, the quality of information increased and length decreased.6,26,41 The absence of mentoring and education training for hand-off communication has added to the inconsistencies and miscommunications associated with the hand-off.6,28


According to the research, nurses associated the following features with the quality of nurse-to-nurse hand-off communication: a systematic approach, the use of nursing documentation,14 bedside hand-off,12,38 efficient communication,14 and the use of a standardized integrated hand-off tool.19,26 Nurses perceived that the bedside hand-off improved accuracy and efficiency and reduced errors.12,38 Nurses expressed increased satisfaction with hand-off quality and consistency after the implementation of a standardized hand-off tool.19,26 Surprisingly, in one study, nurses expressed reluctance to change the hand-off communication style and format despite negative perceptions of and dissatisfaction with the existing hand-off.28


Communication and Communication Patterns

The next theme in nurse-to-nurse hand-off communication research focused on communication patterns, relationships, networks, and the source of the communication. In relation to nursing hand-off, communication pattern is defined as verbal exchange and flow of information on a nursing unit, between nurses and between shifts.43,46,47 Failures in the flow or pattern of communication lead to preventable errors.3 The primary communication network and pattern used for the hand-off is verbal communication. A nurse providing a verbal hand-off extracts pertinent patient information from a variety of sources other than nursing to provide a holistic picture of the patient.44 A nursing unit incorporates more than one communication network pattern (eg, day shift and night shift).43 The pattern of communication between networks during the hand-off affects the safety and quality outcomes of a nursing unit.43 The pattern of the hand-off communication can vary as the composition of network communication changes.43 Additional factors that affect communication and patterns of communication are socioemotional behavioral characteristics. Communication behavior is defined as the associated nonverbal cues, such as tone of voice, body language, and ritualistic nature of the hand-off.3,33,36,40,47 A communication style that projects trust and warmth and uses easily understood language creates an environment that facilitates the exchange of information during the hand-off.40


Research has demonstrated that the hand-off communication is an interactive, collaborative process that involves both the giving and receiving nurses.33 This interactive communication serves as a vehicle for information seeking and verification.33,40 The use of questions during the hand-off is an example of interactive communication. Questions provide both the giving and receiving nurses the ability to confirm the information, request additional information, and receive clarification of information.36,40 Ultimately, the utilization of questions during the nurse-to-nurse hand-off functions as a safety check in preventing the miscommunication of information.36


Electronic Tool Usage and Memory/Cognition

The research on the use of electronic tools, electronic forms, or electronic health record (EHR)-generated forms is limited. The literature did not identify a specific EHR-generated form, electronic tool, or electronic forms used during the hand-off communication. The literature defines an electronic tool as an EHR-generated form or application on a computer that is used primarily in the hand-off communication.7,8,39 Nurses typically do not use EHR-generated forms, the EHR, or other electronic tools for the nurse-to-nurse hand-off communication.8,39 The nurses indicated the EHR and other electronic tools interfered with the flow of the process7,8 and that the EHR and other electronic devices were not able to provide pertinent information quickly.8 The nurses relied on memory, paper charts, and paper records39 and preferred to use personal handwritten notes to give and retrieve patient information.8


The functions of memory and cognition are defined as the recall and mental processing of data, information, and knowledge.34 The nurse-to-nurse hand-off communication is a cognitively intense process with high risk for lapses in the recall of information. The experience level of the healthcare professional does influence the ability to recall pertinent patient information for the hand-off34; experienced healthcare providers can recall more relevant information than novices.34 This capability is attributed to the experienced professional's ability to use running memory and reorganize the hand-off information based on a previous mental model.34


Hand-off Content

Content of the nurse-to-nurse hand-off communication is defined by the literature as patient data, information, and clinical knowledge that is communicated from one nurse to another.6-8,32,42 What is transferred during the nurse-to-nurse hand-off communication? Current research indicates that knowledge, to a certain extent, and information are exchanged verbally42; however, this did not include the plan of care, patient goals, or patient education,42 but of a statement connecting patient status, assessments, interventions, and outcome.42 Data, which include singular individual items or facts, were not transferred during the hand-off.42 Information, or connected data points, was the primary form of patient information verbally communicated during the hand-off.42 Patient information includes patient signs and symptoms and associated interventions.42 Current nursing research is primarily concerned with the structure of the hand-off and not the actual content of the message.



Nurse-to-nurse hand-off communication has been the subject of extensive research subsequent to The Joint Commission's 2006 recommendation to implement a standardized hand-off communication. Research has focused on nurses' perceptions and satisfaction, communication patterns and behavior, electronic tool usage, memory/cognition, content, and standardization of the hand-off. Nurse perceptions of existing processes identified several factors that influence the hand-off communication: environmental distractions,4,39,41 inconsistency, lack of structure,4,6,11,37 time consumed,12,28,41 insufficient time allotted for the hand-off,28 hand-off containing irrelevant information,12 and the lack of pertinent patient data.4,28


The primary method for communicating the hand-off information is a verbal exchange between nurses. The communication network of a nursing unit is composed of multiple nodes (day shift, night shift, nurses, and unlicensed personnel).43 The flow of communication and information can vary as the composition of the network fluctuates.43 Additionally, socioemotional and behavioral characteristics negatively and positively affect the communication pattern between nurses.40 The nurse-to-nurse hand-off communication is an interactive process of information seeking and verification through the use of questions.33,40


A general school of thought holds that electronic tools would enhance the hand-off communication and decrease the cognitive load of the nurse. The research indicates nurses are not using electronic tools, EHRs, or EHR-generated forms for the hand-off.8,39 Nurses prefer to rely on memory, "brain-sheets," and paper charts rather than the EHR.8 The reliance on memory is a high-risk strategy because of the cognitively intense nature of the nurse-to-nurse hand-off process. The ability to successfully recall relevant information correlates to the individual's professional experience.34 An experienced professional utilizes running memory to reorganize the hand-off information to recall pertinent patient information successfully.34


The research on hand-off standardization focuses on the structure and consistency of the hand-off but not the content. The limited research on hand-off content indicates that both knowledge and information are currently exchanged in nurse-to-nurse hand-off communication.42 Standardized tools for the hand-off have been implemented with the intent to improve the structure and consistency, decrease information overload, and improve the quality of the information communicated during the hand-off.32 A strategic plan and an assessment of the culture and workflow of the nursing unit are crucial to the success of implementing a standardized hand-off procedure and tool.2,13,16,35 The positive outcomes after implementation of a standardized hand-off are a perceived increase in the following areas: effectiveness of the hand-off communication,20 satisfaction with the hand-off procedure,35 organization, and overall content.13,24 There are no studies that can provide a direct correlation between implementing a standardized hand-off tool and improved patient outcomes.



In this project, a universal solution for effective nurse-to-nurse hand-off communication was not identified or found. The literature on nurse perceptions of and satisfaction with the hand-off has reached a saturation point. Additionally, the current literature is inundated with research on how and why to implement a standardized hand-off tool. We know nurses are more satisfied with structured, consistent hand-off processes. An identified gap in the research is connecting the use of a standardized hand-off procedure to patient outcomes.


Miscommunications and errors of omission continue to occur despite the multitude of studies on nurse-to-nurse hand-off communication. The nurse-to-nurse hand-off communication system is part of the healthcare sociotechnical system, increasing the complexity of how the message is communicated and the content of the message. The conduit for the hand-off is a complex multichannel communication comprising both human-to-human interaction (verbal) and human-to-computer interaction (electronic tools and the EHR). Currently, there is minimal research on the content of the message being communicated. What is the content of the hand-off message? What is being transferred in the hand-off communication? Additionally, does the message contain too much irrelevant information resulting in a cognitive overload for the nurse? Research on the content of the message can lead to decreased errors in the hand-off communication and thus improved patient outcomes.


The introduction of the EHR has changed the nature of the hand-off from a human-to-human interaction (social ritual) to a sociotechnical system. The concept of technology to assist the healthcare provider in decreasing errors, decreasing cognitive load, and improving patient outcomes has not been evident in the research on hand-off communication. Technology should assist and enhance the nurse's running memory and ability to recall pertinent essential patient information. An area for further investigation is the analysis of how human factors and ergonomics affect the hand-off communication in a sociotechnical environment. Nurses in general are not using the EHR, EHR-generated forms or other electronic tools in the hand-off process.8 We know nurses prefer to use verbal communication for the hand-off. What we need to know is how to successfully integrate electronic tools and devices and the EHR into the current hand-off procedure to enhance recall of pertinent patient information. Additional research using a cognitive work analysis to investigate how workflow patterns are affected by the integration of an electronic tool or EHR in nurse-to-nurse hand-off communication is recommended.


Continued research on the nurse-to-nurse hand-off communication process is essential to decrease sentinel events related to miscommunication. The review of the research indicates that nurse scientists must challenge themselves and investigate the hand-off communication from a new perspective. We have the technology available to assist in decreasing the cognitive load of the nurse. The research needs to focus on identifying the human factors affecting the communication and interventions that can be readily implemented. Nurse scientists have a pivotal role in finding and implementing solutions to improve the nurse-to-nurse hand-off communication. We have attempted to provide clarity and direction on where the nurse-to-nurse hand-off communication research must proceed in the future.




1. Joint Commission Center for Transforming Healthcare releases targeted solutions tool for hand-off communications. Joint Commission Perspectives. 2012;32(8): 1, 3. [Context Link]


2. Spruce L. Back to basics: patient care transitions. AORN Journal. 2016;104(5): 426-432. [Context Link]


3. Suominen H, Johnson M, Zhou L, et al. Capturing patient information at nursing shift changes: methodological evaluation of speech recognition and information extraction. Journal of the American Medical Informatics Association. 2015;22(e1): e48-e66. [Context Link]


4. Johnson C, Carta T, Throndson K. Commuicate with me: information exchanges between nurses. Canadian Nurse. 2015;3(2): 4. [Context Link]


5. Joint Commission. Secondary Joint Commission. 2016. Accessed December 4, 2016. [Context Link]


6. Manias E, Geddes F, Watson B, Jones D, Della P. Perspectives of clinical handover processes: a multi-site survey across different health professionals. Journal of Clinical Nursing. 2016;25(1-2): 80-91. [Context Link]


7. Staggers N, Clark L, Blaz JW, Kapsandoy S. Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses' handoffs on medical and surgical units: insights from interviews and observations. Health Informatics Journal. 2011;17(3): 209-223. [Context Link]


8. Staggers N, Clark L, Blaz J, Kapsandoy S. Nurses' information management and use of electronic tools during acute care handoffs. Western Journal of Nursing Research. 2012;34(2): 153-173. [Context Link]


9. Sehgal N. Handoffs and transitions: perspectives on safety. Secondary handoffs and transitions: perspectives on safety 2015. Accessed January 23, 2017. [Context Link]


10. Arora V, Johnson J. A model for building a standardized hand-off protocol. Joint Commission Journal on Quality and Patient Safety. 2006;32(11): 646-655. [Context Link]


11. McFetridge B, Gillespie M, Goode D, Melby V. An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit. British Association of Critical Care Nurses, Nursing in Critical Care. 2007;12(6): 261-269. [Context Link]


12. Chaboyer W, McMurray A, Wallis M. Bedside nursing handover: a case study. International Journal of Nursing Practice. 2010;16(1): 27-34. [Context Link]


13. Smeulers M, Dolman CD, Atema D, van Dieren S, Maaskant JM, Vermeulen H. Safe and effective nursing shift handover with NURSEPASS: an interrupted time series. Applied Nursing Research. 2016;32: 199-205. [Context Link]


14. Klim S, Kelly AM, Kerr D, Wood S, McCann T. Developing a framework for nursing handover in the emergency department: an individualised and systematic approach. Journal of Clinical Nursing. 2013;22(15-16): 2233-2243. [Context Link]


15. Bruno GM, Guimond ME. Patient care handoff in the postanesthesia care unit: a quality improvement project. Journal of Perianesthesia Nursing. 2017;32(2): 125-133. [Context Link]


16. Smeulers M, Vermeulen H. Best of both worlds: combining evidence with local context to develop a nursing shift handover blueprint. International Journal for Quality in Health Care. 2016;28(6): 749-757. [Context Link]


17. Kitney P, Raymond T, Bennett P, Buttigieg D, Wang W. Handover between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR principles: a quality improvement study. Journal of Perioperative Nursing in Australia. 2016;29(1): 30-35. [Context Link]


18. Bakon S, Wirihana L, Christensen M, Craft J. Nursing handovers: an integrative review of the different models and processes available. International Journal of Nursing Practice. 2017;23(2). [Context Link]


19. Johnson M, Sanchez P, Zheng C. The impact of an integrated nursing handover system on nurses' satisfaction and work practices. Journal of Clinical Nursing. 2016;25(1-2): 257-268. [Context Link]


20. Tucker A, Fox P. Evaluating nursing handover: the REED model. Nursing Standard. 2014;28(20): 44-48. [Context Link]


21. Rose M, Newman S. Factors influencing patient safety during postoperative handover. American Association of Nurse Anesthetists Journal. 2016;84(5): 10. [Context Link]


22. Cornell P, Gervis MT, Yates L, Vardaman JM. Impact of SBAR on nurse shift reports and staff rounding. Medsurg Nursing. 2014;23(5): 334-342. [Context Link]


23. Huth K, Hart F, Moreau K, et al. Real-World Implementation of a Standardized Handover Program (I-PASS) on a pediatric clinical teaching unit. Academic Pediatrics. 2016;16(6): 532-539. [Context Link]


24. Street M, Eustace P, Livingston P, Craike M, Kent B, Patterson D. Communication at the bedside to enhance patient care: a survey of nurses' experience and perspective of handover. International Journal of Nursing Practice. 2011;17(2): 133-140. [Context Link]


25. Chapman Y, Schweickert P, Swango-Wilson A, Aboul-Enein F, Heyman A. Nurse satisfaction with information technology enhanced bedside handoff. MedSurg Nursing. 2016;25(5): 6. [Context Link]


26. Gage W. Evaluating handover practice in an acute NHS Trust. Nursing Standard. 2013;27(48): 43-50. [Context Link]


27. Smeulers M, Lucas C, Vermeulen H. Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients. The Cochrane Database of Systematic Reviews. 2014;(6): CD009979. [Context Link]


28. Kerr D, Lu S, McKinlay L, Fuller C. Examination of current handover practice: evidence to support changing the ritual. International Journal of Nursing Practice. 2011;17(4): 342-350. [Context Link]


29. Staggers N, Blaz J. Research on nursing handoffs for medical and surgical settings: an integrative review. Journal of Advanced Nursing. 2013;69(2): 247-262. [Context Link]


30. Abdellatif A, Bagian JP, Barajas ER, et al. Communication during patient hand-overs. Joint Commission Journal on Quality and Patient Safety. 2007;33(7): 439-442. [Context Link]


31. Anderson J, Malone L, Shanahan K, Manning J. Nursing bedside clinical handover-an integrated review of issues and tools. Journal of Clinical Nursing. 2015;24(5-6): 662-671. [Context Link]


32. Johnson M, Jefferies D, Nicholls D. Exploring the structure and organization of information within nursing clinical handovers. International Journal of Nursing Practice. 2012;18(5): 462-470. [Context Link]


33. Abraham J, Kannampallil T, Brenner C, et al. Characterizing the structure and content of nurse handoffs: a sequential conversational analysis approach. Journal of Biomedical Informatics. 2016;59: 76-88. [Context Link]


34. Anderson-Montoya B, Scerbo M, Ramirez D, Hubbard T. Running memory for clinical handoffs: a look at active and passive processing. Human Factors. 2017;59(3): 393-406. [Context Link]


35. Patton LJ, Tidwell JD, Falder-Saeed KL, Young VB, Lewis BD, Binder JF. Ensuring safe transfer of pediatric patients: a quality improvement project to standardize handoff communication. Journal of Pediatric Nursing. 2017;(34): 44-52. [Context Link]


36. Rixon S, Braaf S, Williams A, Liew D, Manias E. The functions and roles of questioning during nursing handovers in specialty settings: an ethnographic study. Contemporary Nurse. 2017;53(2): 182-195. [Context Link]


37. Bruton J, Norton C, Smyth N, Ward H, Day S. Nurse handover: patient and staff experiences. The British Journal of Nursing. 2016;25(7): 386-390, 392-393. [Context Link]


38. Small A, Gist D, Souza D, Dalton J, Magny-Normilus C, David D. Using Kotter's change model for implementing bedside handoff: a quality improvement project. Journal of Nursing Care Quality. 2016;31(4): 304-309. [Context Link]


39. Kowitlawakul Y, Leong BS, Lua A, et al. Observation of handover process in an intensive care unit (ICU): barriers and quality improvement strategy. International Journal for Quality in Health Care. 2015;27(2): 99-104. [Context Link]


40. Streeter A, Harrington N, Lane D. Communication behaviors associated with the competent nursing handoff. Journal of Applied Communication Research. 2015;43(3): 294-314. [Context Link]


41. Brown J, Sims S. Nursing clinical handover in neonatal care. Contemporary Nurse. 2014;49: 50-59. [Context Link]


42. Matney S, Maddox L, Staggers N. Nurses as knowledge workers: is there evidence of knowledge in patient handoffs? Western Journal of Nursing Research. 2014;36(2): 171-190. [Context Link]


43. Effken JA, Gephart SM, Brewer BB, Carley KM. Using *ORA, a network analysis tool, to assess the relationship of handoffs to quality and safety outcomes. Comput Inform Nurs. 2013;31(1): 36-44. [Context Link]


44. Jefferies D, Johnson M, Nicholls D. Comparing written and oral approaches to clinical reporting in nursing. Contemporary Nurse. 2012;42(1): 129-138. [Context Link]


45. DeSantis L, Ugarriza D. The concept of theme as used in qualitative nursing research. Western Journal of Nursing Research. 2000;22(3): 351-372. [Context Link]


46. Coiera E. Guide to Health Informatics. 3rd ed. Boca Raton, FL: CRC Press, Taylor & Francis Group; 2015. [Context Link]


47. Benham-Hutchins MM, Effken JA. Multi-professional patterns and methods of communication during patient handoffs. International Journal of Medical Informatics. 2010;79(4): 252-267. [Context Link]