Multidisciplinary communication to support nurse-to-nurse handover at patient transfer from the Emergency Department to acute medical ward

Mr Darcy O’Connor1, Dr  Bernice  Redley1,2, Dr Helen Rawson1,2

1Deakin University, Burwood, Australia, 2Monash Health, Clayton, Australia


Little is known about how goals for multidisciplinary team communication, as specified by Australian national safety standards, are operationalised during clinical handover when complex patient care is transferred from the Emergency Department (ED) to an acute medical ward. This research examined nurses’ communication of multidisciplinary care during the transfer of complex patients from the ED to acute medical wards.


The naturalistic, mixed-methods design used observation, audit and interview data collected from a convenience sample of 38 nurses involved in transfer of care for 19 complex patients from the ED to medical wards at a single tertiary hospital, and a focus group with 17 multidisciplinary clinicians.


Each complex medical patient was seen by 3 to 6 different health professionals in the ED, but this was seldom communicated between nurses during the transfer of ongoing responsibility for patient care to the ward. Observations identified over 90% of handovers included at least three of the four Connect, Observe, Listen and Delegate (COLD) steps in the patient transfer processes. However, inconsistent practices, duplication and gaps in handover communication negatively impacted the efficiency of transfers and effective delegation of responsibility for ongoing care. Practices known to increase patient risk were observed in over half (53%) of the patient transfers.


Gaps in communication of multidisciplinary care and behaviours inconsistent with best practice recommendations contributed to safety risks for complex patients during transfer of their care from the ED to acute medical wards. Organisational policies, interdepartmental relationships and tensions between meeting demands for efficiency and quality also contributed to risk.


Darcy completed his Bachelor of Nursing with Federation University in  2016. In 2017 he completed a graduate program with Monash Health working in geriatrics and rehabilitation, and the Emergency Department. His passion for emergency care lead him to complete a Bachelor of Nursing (Honours) with Deakin University in the field of communication of multidisciplinary during transitional phases of  ED care.