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Handover Structure and Quality in the Acute Medical Assessment Unit

A Prospective Observational Study

van der Wulp, Ineke, PhD*; Poot, Else P., MScN; Nanayakkara, Prabath W.B., PhD; Loer, Stephan A., PhD§; Wagner, Cordula, PhD*∥

doi: 10.1097/PTS.0000000000000221
Original Article: PDF Only

Objectives Inadequate patient handovers are associated with the occurrence of medical errors. The objective of the present study was to explore the structure and quality of handovers in the acute medical assessment unit.

Methods A prospective observational study was conducted in an academic hospital in the Netherlands. Handover structure was observed by ordering handover information according to the elements of the Situation, Background, Assessment, Recommendation, and Read back (SBAR-R) handover tool. Handover quality was measured by means of a questionnaire, i.e., the rating tool for handover quality, and by assessing situation awareness of the degree to which professionals after a handover agreed on the complexity of the patient's care needs.

Results A total of 71 handovers were observed. In most handovers, different elements of the SBAR-R were used frequently (median, 7.5 elements; range, 2.0–15.0). On the quality of handovers, 109 respondents (44.1%) completed the questionnaire. On a 0-to-100 scale, median scores on information transfer were 67.9 (interquartile range [IQR],17.9), 75.0 (IQR, 25.0) on shared understanding, and 75.0 (IQR, 16.7) on working atmosphere. Agreement in situation awareness was 70.0%.

Conclusions Handovers in the acute medical assessment unit were poorly structured; however, the perceived quality of handovers was substantial. Implementing the SBAR-R may be an effective strategy to improve handover practice and situation awareness, although further study to its applicability in acute medical assessment units is necessary.

From the *Department of Social Medicine, VU University Medical Center/EMGO+ Institute, Amsterdam, The Netherlands; †Working Party on Infection Prevention, Leiden University Medical Center, Leiden, The Netherlands; ‡Section of Acute Medicine, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; §Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands; and ∥The Netherlands Institute of Health Services Research, NIVEL, Utrecht, the Netherlands.

Correspondence: Ineke van der Wulp, PhD, Department of Social Medicine, VU University Medical Center/ EMGO+ Institute, Van der Boechorststraat 7. 1081 BT Amsterdam, The Netherlands (e-mail:

C. Wagner reported membership in a board of trustees. The other authors disclose no conflict of interest.

No funding was received for this work.

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