What is the best nursing handover style to ensure continuity of information for hospital patients?

What is a nursing handover?

A nursing handover occurs when one nurse hands over the responsibility of care for a patient to another nurse, for example, at the end of a nursing shift. On average, nursing handovers occur three times a day for each patient.

What styles of nursing handover exist?

In daily practice handovers are done in various ways, some handovers are done through nurses talking to each other (verbal handovers). Others are done through nurses reading the patient’s medical notes or through a combination of reading and talking to each other. In some cases they are done at the patient’s bedside, so that the patient can contribute, if desired.

Why does the style of nursing handovers need to be investigated?

When a nurse hands over responsibility of care to another nurse there is an opportunity for error if all the important medical information is not shared thoroughly and efficiently. Failing to mention - or grasp - information may result in delays in treatment or diagnosis for the patient, inappropriate treatment, or failure to provide appropriate care. Consequently, an accurate handover of clinical information is essential to ensure continuity of care and patients’ safety.

The purpose and findings of this review

This review tried to find out which nursing handover style works best.

In March 2013 the review authors conducted a wide search for suitable relevant studies (randomised controlled studies) that compared different styles of nursing handover. However, they were not able to identify any randomised controlled studies that investigated the question, and so could draw no conclusions. Further research in this area is urgently needed.

Authors' conclusions: 

There was no evidence available to support conclusions about the effectiveness of nursing handover styles for ensuring continuity of information in hospitalised patients because we found no studies that fulfilled the methodological criteria for this review. As a consequence, uncertainty about the most effective practice remains. Research efforts should focus on strengthening the evidence abut the effectiveness of nursing handover styles using well designed, rigorous studies. According to current knowledge, the following guiding principles can be applied when redesigning the nursing handover process: face-to-face communication, structured documentation, patient involvement and use of IT technology to support the process.

Read the full abstract...

An accurate handover of clinical information is of great importance to continuity and safety of care. If clinically relevant information is not shared accurately and in a timely manner it may lead to adverse events, delays in treatment and diagnosis, inappropriate treatment and omission of care. During the last decade the call for interventions to improve handovers has increased. These interventions aim to reduce the risk of miscommunication, misunderstanding and the omission of critical information.


To determine the effectiveness of interventions designed to improve hospital nursing handover, specifically:

to identify which nursing handover style(s) are associated with improved outcomes for patients in the hospital setting and which nursing handover style(s) are associated with improved nursing process outcomes.

Search strategy: 

We searched the following electronic databases for primary studies: Cochrane EPOC Group specialised register (to 19 September 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (to 1 March 2013), MEDLINE (1950 to 1 March 2013) OvidSP, EMBASE (1947 to 1 March 2013) OvidSP, CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1980 to 1 March 2013) EbscoHost and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index) (to 9 July 2012). The Database of Abstracts of Reviews (DARE) was searched for related reviews. We screened the reference lists of included studies and relevant reviews. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) http://www.who.int/ictrp/en/ and Current Controlled Trials www.controlled-trials.com/mrct and we conducted a search of grey literature web sites.

Selection criteria: 

Randomised controlled trials (RCTs or cluster-RCTs) evaluating any nursing handover style between nurses in a hospital setting with the aim of preventing adverse events or optimising the transfer of accurate essential information required for continuity of care, or both.

Data collection and analysis: 

Two review authors independently assessed trial quality and extracted data.

Main results: 

The search identified 2178 citations, 28 of which were considered potentially relevant. After independent review of the full text of these studies, no eligible studies were identified for inclusion in this review due to the absence of studies with a randomised controlled study design.