Table 1 Traditional versus continuity-enhanced handovers in teaching hospitals

Transfer of information

As little information as possible is given, so as not to “burden” cross-cover with any tasks

The primary team sender apologizes to the night float covering physician during handoff: “I got a new patient today and I tried to tuck her in so you should not have any trouble. The only thing is that GI may call with recs.”

A robust interactive exchange occurs to promote a shared mental model with active conversation

The primary team sender engages the night-float covering physician by sharing her thought process and rationale: “I got a new patient today… she is a 25 yo female who recently completed a course of ciprofloxacin and now has abdominal pain. I ordered a GI consult because of her elevated liver enzymes. I am wondering if she has drug-induced liver injury.”

Professional responsibility

The individual physician or “primary team” transfers responsibility to a “covering physician”

Later that evening the GI consult team calls and asks the night float covering physician whether the patient has had a PT/INR test. The covering physician replies, “This is not my patient.”

A team of clinicians who share responsibility equally for the patient

Later that evening, the GI consult team calls and asks the night-float covering physician whether the patient has had a PT/INR test. The covering physician says, “I did not hear that during handover, but I will check and get back to you.”

Philosophy of “coverage”

The covering physician temporizes until the primary physician team returns

The next morning, the night float physician says to the primary team, “The consult team called and wanted you to order an abdominal ultrasound.”

All team members advance care through handover

The next morning, the night float physician says to the primary team, “The consult team called and wanted to order an abdominal ultrasound so I arranged for it this morning.”

Learning

Learning is limited to the individual physician or team dealing with the patient

The primary physician reads about the utility of abdominal ultrasound to diagnose drug-induced liver injury.

Handovers are used as a learning opportunity for all clinicians present

During handover,the sender and receiver discuss indications for abdominal ultrasound in this patient.

Scheduling / staffing

The time when an individual physician responsible for patient is present is maximized

The primary team sender stays late to meet the family because the covering physician does not know the patient’s situation well enough to meet the family and discuss the patient’s prognosis.

The time when any member of primary care team is present is maximized

The primary team sender can leave the hospital after her shift and hands the patient’s care over to another physician, who is also member of the primary team and meets with family to discuss the patient’s prognosis.