Emerg Med J 29:941-946 doi:10.1136/emermed-2011-200199
  • Original articles

The ABC of handover: a qualitative study to develop a new tool for handover in the emergency department

Open Access
  1. Charles Vincent2
  1. 1Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College, London, UK
  1. Correspondence to Dr Maisse Farhan, Emergency Department, First Floor QEQM, St Mary's Hospital, Praed Street, London W2 1NY, UK; maisse.farhan{at}
  1. Contributors All authors contributed to the design of the study. MF collected and analysed the data. RB and MW reviewed the data analysis. MF wrote the manuscript. All authors contributed to its revision.

  • Accepted 20 November 2011
  • Published Online First 3 January 2012


Objectives This study identifies best practice for shift handover and introduces a new tool used to hand over clinical and operational issues at the end of a shift in the emergency department (ED).

Methods Literature review, semi-structured interviews and observations of handover were used to develop a standardised process for handover. Participants were ED middle grades, consultants and senior nurses. Interviews were used to identify agreed best practice and derive a tool to classify the information into relevant sections.

Results Interviews identified a variety of perceived current deficits in handover including a lack of standardised practice and structure. Participants provided examples of poor handover that were thought to have led to adverse events; these included delay in investigations and treatment for patients who were handed over with brief or inaccurate information. There was wide variation in the understanding of the meaning and purpose of shift handover, and differences were apparent according to the level of experience of the middle grades interviewed. The experts' responses were used to reach a unifying ‘best practice’ for the content of handover. This was then grouped under ABCDE headings to develop the ABC of handover tool.

Conclusions A simple tool was developed to provide the basis for medical shift handover, which includes clinical and operational information necessary for efficiency and organisation of the next shift. The ABC of handover classifies shift information to be handed over under the ABCDE headings, which are easy to remember and highly relevant to emergency medicine.


  • Funding Funding was provided by the London Deanery for MF to conduct research in clinical safety and in collaboration with the Clinical Safety Research Unit. The Clinical Safety Research Unit is affiliated with the Centre for Patient Safety and Service Quality at Imperial College London, which is funded by the National Institute of Health Research

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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