Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Emergency Medicine


Dr Larry Herman




This article explores how creating an efficient, effective method for end of shift patient hand off in the Emergency Department (ED) can address conservation of healthcare resources through reduced medical error, decreased sentinel events, and improved patient care. Standardizing this method across the specialty would create an easier transition for providers who work in various locations. Standardization of a hand off method would also ensure all stakeholders have appropriate education and utilization instructions.


A literature search of Pub Med, Google Scholar, and the database of the Annals of Emergency Medicine was conducted with the date range from 2012 until the present and then refined to 2016 until the present, using the search terms “Emergency Department,” “end of shift,” “hand off,” “error,” and “sign out.” Fifty-four pertinent articles were retrieved and served as the basis for this clinical review. Cited resources of pertinent articles were reviewed and served as an additional source for relevant articles.


All the articles focusing on hand off, no matter the specialty, recognized the transfer of care as a principal source of potential medical error and attributed this to various intrinsic and extrinsic factors. A variety of suggestions and recommendations were identified concerning end of shift hand off for various specialties, with some recommending a specific method but none recommending a specific method standardized across the specialty of Emergency Medicine (EM).


Medical error is the third leading cause of death in the United States (US).1 EDs continue to suffer from overcrowding and lack of staffing which creates an environment that needs a more structured method of transferring care between providers.2 The risk of patient harm through miscommunication can be significantly mitigated, if not eliminated, with the implementation of a standardized end of shift hand off procedure in the ED.

Keywords: Emergency Department, end of shift, sign out, hand off, error, patient harm, and overcrowding.


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