International Journal of Research Foundation of Hospital and Healthcare Administration

Register      Login

VOLUME 3 , ISSUE 1 ( January-June, 2015 ) > List of Articles


Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India

V Jithesh, Parmeshwar Kumar, Aarti Vij

Citation Information : Jithesh V, Kumar P, Vij A. Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India. Int J Res Foundation Hosp Healthc Adm 2015; 3 (1):33-40.

DOI: 10.5005/jp-journals-10035-1034

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2015; The Author(s).



Standardized handovers have been known to improve outcome, reduce error and enhance communication. Few, if aany, comparative studies on clinical handovers have been conducted in the India.


To study clinical handover practices among nurses and doctors in a neurosciences center in India.

Design and setting

This descriptive and cross-sectional study was conducted over 4 months in a 200 bedded public sector tertiary care facility in New Delhi, India.

Materials and methods

The handover practices of nurses and resident doctors in a neurology ward were assessed across shifts, weekdays and weekends using a pretested checklist. Ten elements were observed under the categories of time, place, record, process, staff interaction and patient communication. Outcomes were analyzed using z-test, analysis of variance (ANOVA) and Spearman's correlation coefficient.


Three hundred and eighty-two handovers each of nurses and doctors revealed varying adherence for time (44%), place (63%), documentation (50%), process (78%), staff interaction (50%) and patient communication (45%) related elements with overall compliance being 55%. Doctors fared better only in process elements and bedside handovers; however, only nurses had a statistically significant fall in levels over weekends and in night shifts. Staff interaction and patient communication were positively correlated and bedside handover was negatively related to handover duration in both groups. No statistically significant difference was found between the two groups when assessed as categories.


Study revealed a need for a system change and standardization of clinical handovers. Greater administrative commitment, use of technology, customized training and leadership development will aid in continuity of care, promote patient safety and ensure better outcomes.

How to cite this article

Kumar P, Jithesh V, Vij A, Gupta SK. Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India. Int J Res Foundation Hosp Healthc Adm 2015;3(1):33-40.

PDF Share
  1. Exploring emergency physician-hospitalist handoff interactions: development of the handoff communication assessment. Ann Emerg Med 2010 Feb;55(2):161-170.
  2. ACSQHC, 2012. Available at: Accessed on: 18 Dec 2013.
  3. Safe handover: safe patients. Guidance on clinical handover for clinicians and managers. 2006. Available at: (Accessed on: 30 Sep 2013).
  4. Investigating the scope of resident patient care handoffs within neurosurgery. PLoS One 2012;7(7):e41810
  5. An experimental comparison of handover methods. Ann R Coll Surg Engl 2007 Apr;89(3):298-300.
  6. Handover: faster and safer. J Clin Nurs 2014 Jul;23(13-14):1927-1936.
  7. The truth about language barriers: one residency program's experience. Pediatrics 2003;111(5 Pt 1):e569–e573.
  8. Patient's perceptions of bedside handovers. J Clin Nurs 1998 July;7(4):351-359.
  9. The conflict management style of staff nurses and nurse managers. J Adv Nurs 1991 Oct;16(10):1254-1260.
  10. Bedside handover: quality improvement strategy to ‘transform care at the bedside’. J Nurs Care Qual 2009 Apr-Jun;24(2):136-142.
  11. ALS patients and caregivers communication preferences and information seeking behaviour. Eur J Neurol 2008 Jan;15(1):55-60.
  12. Discourses of anxiety in nursing practice: a psychoanalytic case study of the changeof-shift handover ritual. Nurs Inq 2008 Mar;15(1):40-48.
  13. Living for the weekend: electronic documentation improves patient handover. Clin Med 2012 Apr;12(2):124-127.
  14. Characterising physician listening behaviour during hospitalist handoffs using the HEAR checklist. BMJ Qual Saf 2013 May;22(3):203-209.
  15. Understanding communication during hospitalist service changes: a mixed methods study. J Hosp Med 2009 Nov;4(9):535-540.
  16. Hawthorne effects and research into professional practice. J Eval Clin Pract 2001 Feb;7(1):65-70.
  17. Available at: Accessed on: 26 Nov 2013.
  18. A qualitative study of shift handover practice and function from a sociotechnical perspective. J Adv Nurs 2002 Jan;37(2):125-134.
  19. An investigation into the functions of nurses’ communication at the inter-shift handover. J Nurs Manag 1999 Jan;7(1):29-36.
  20. The information content of the nurse change of shift report: a comparative study. J Adv Nurs 2000 Apr;31(4):794-804.
  21. Medication communication between nurses and patients during nursing handovers on medical wards: a critical ethnographic study. Int J Nurs Stud 2012 Aug;49(8):941-952.
  22. The content of nurses’ oral shift reports in homes for elderly people. J Adv Nurs 1993 Jul;18(7):1095-1100.
  23. Implementing bedside handover: strategies for change management. J Clin Nurs 2010 Sep;19(17-18):2580-2589.
  24. Nurses’ perception of shift handovers in Europe: results from the European Nurses’ early exit study. J Adv Nurs 2007 Mar;57(5):535-542.
  25. Linguistic and cultural barriers to care. J Gen Intern Med 2003 Jan;18(1):44-52.
  26. Interactions between nurses during handovers in elderly care. J Adv Nurs 2000 Aug;32(2):277-285.
  27. ‘Handing over’: transmission of information between nurses in an intensive therapy unit. Nurs Crit Care 2006 Mar-Apr;11(2):86-93.
  28. iSoBAR — concept and handover checklist: the national clinical handover initiative. Med J Aust 2009 Jun 1;190(11 suppl):S152-156.
  29. The importance of the verbal shift handover report: a multi-site case study. Int J Med Inform 2011 Nov;80(11):803-812.
  30. SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study. BMJ Open 2014 Jan;4(1):e004268.
  31. Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners. BMJ Qual Saf 2014 Jun;23(6):483-489.
  32. Available at: 0/root_cause_se.jpg, Accessed on: 12 Sep 2013.
  33. Available at: 20patients.pdf. Accessed on 12 Dec 2013.
  34. An educational intervention to increase ‘Speaking-Up’ behaviors in nurses and improve patient safety. J Nurs Care Qual 2012 Apr-Jun;27(2):154-160.
  35. Closing the loop: physician communications with diabetic patients who have low health literacy. Arch Intern Med 2003 Jan 13;163(1):83-90.
  36. Patients’ perceptions on healthcare decision making in rural India: a qualitative study and ethical analysis. J Clin Ethics 2009 Summer;20(2):150-157.
  37. Nursing handovers: do we really need them? J Nurs Manag 2004 Jan;12(1):37-42.
  38. Examining links between sign-out reporting during shift changeovers and patient management risks. Risk Anal 2008 Aug;28(4):969-981.
  39. Graduate medical education and patient safety: a busy-and occasionally hazardousintersection. Ann Intern Med 2006 Oct 17;145(8):592-598.
  40. American Medical Association. Available at: Accessed on 11th Jan 2014.
  41. Beyond communication: the role of standardized protocols in a changing healthcare environment. Healthcare Manage Rev 2012 Jan-Mar;37(1):88-97.
  42. The participation of hospital nurses in the multidisciplinary ward round on a cancer-therapy ward. J Clin Nurs 2004 Feb;2(3):155-163.
  43. Health Research Methodology. 2nd ed. Manila: WHO Regional Office for the Western Pacific, 2001.
  44. ‘Hand me an isobar’: a pilot study of an evidence-based approach to improving shift-toshift clinical handover. Med J Aust 2009 Jun 1;190(11 Suppl):S121-124.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.