It’s the ED I have a patient to handover: The development of the ED to ward clinical handover tool

Mrs Naomi Clark1, Mrs Kate Ruperto2, Ms  Janet  White3

1Wollongong Hospital Emergency Department, Wollongong , Australia; 2Illawarra Shoalhaven Local Health District, Wollongong, Australia; 3IMSD (SESLHD, ISLHD, SCHN- Randwick), Wollongong, Australia

Clinical handover is defined as “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or a group of patients, to another person or professional group on a temporary or permanent basis” ¹.  However clinical handover from the ED to the ward nurse has been met with the challenges of inconsistency between staff, competing needs of the handover and the documentation of this in the electronic medical record.

A failure to meet the MoH Clinical Handover- Standard Key Principles PD2009_060 criteria for the handover process led to development of an ED to Ward Clinical Handover tool.  The handover tool was developed utilising the ISBAR framework whilst meeting the needs of the ED, ward and key standards of the handover process.

The tool was trialed in paper form on a medical and cardiac ward, two surgical wards and paediatric ward over a month. This allowed for testing of the framework and content. Feedback from ED and ward nursing staff allowed this tool to be reviewed and developed for four emergency departments across our local health district for utilisation in the electronic medical record.

The development of an electronic handover form has required a multi stakeholder approach across the district. The challenges included the development of the IT format, the agreed handover process, additional infrastructure, the health district structure and education. However the benefit of a documented handover between clinicians, which is time stamped with an electronic signature meets the requirements of the clinical handover policy thus promoting best practice. We envision the implementation of the electronic tool with further testing resulting in a reduction of clinical incidences relating to clinical handover.

  1. Australian Commission of Safety and Quality in Healthcare, 2012, National Safety and Quality Health Service (NSQHS) Standards Standard 6; Clinical Handover, p.6.


Naomi Clark has been working in the emergency department environment for 12 years and held both clinical and management roles. She has completed post graduate degrees in emergency nursing and healthcare management. As a Nurse Unit Manager (Grade 2) Naomi has key interests in quality improvement initiatives, the implementation of National Safety and Quality Health Service (NSQHS) Standards in the emergency department and the professional development of the emergency nurse.