Nursing handover of vital signs at the transition of care from the emergency department to the inpatient ward: An integrative review

Rachel Cross1,2, Professor Judy  Currey2, Professor Julie Considine2,3

1La Trobe University, Melbourne, Australia, 2Deakin University, Burwood , Australia, 3Eastern Health, Box Hill , Australia

Aim: To examine current handover of vital signs during patient transfer from the emergency department (ED) to the inpatient ward.

Background: Clinical handover is an international healthcare priority. The transition of care from the ED to the inpatient ward is informed by nursing handover. Vital sign abnormalities in the ED are predictive of clinical deterioration following hospital admission. Understanding the inclusion of vital sign content in clinical handover is important for patient safety.

Methods: An integrative design was used. A search of electronic databases was undertaken using MEDLINE, CINAHL, EMBASE, COCHRANE, Web of Science, SCOPUS. Identified records were also screened to elicit further studies for inclusion. A comprehensive peer review screening process was performed. Studies were included that described the issues of handover, vital signs, emergency department, transition of care and ward.

Results: Four studies were included in the final review. All were specific for emergency medicine. None were specific for emergency nursing handover. Identified studies were evaluated to identify similarities and differences; two themes emerged. Vital signs were incorporated into clinical handover at varying levels and were perceived to be an important inclusion. Vital signs were also perceived to be indicators for patient safety, and risk factors for future clinical deterioration.

Conclusion: Vital signs were included at varying levels in clinical handover. No studies were specific for ED to ward nursing handover despite nurses having a key role in the measurement and interpretation of vital signs and escalation of care. Deficiencies in vital sign content were perceived to be risk factors for patient adverse events following hospital admission. The quality of vital sign information in clinical handover may be important for accurate decision making.

Implications: Vital signs are an important component of clinical handover and are perceived to be indicators for patient safety and risk for future clinical deterioration.


Rachel Cross is a PhD candidate examining the transition of patient care from the emergency department to the inpatient ward. Her PhD is focused on clinical deterioration and clinical handover. Rachel works as a Lecturer and an emergency nurse in a major metropolitan hospital in Melbourne Victoria.