Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing


The handover between the emergency department (ED) and in-patient units is a complex process that involves a transfer of responsibility with a change in care providers and physical location (Horwitz et al., 2009). Inadequate communication handovers have been identified as the primary root cause in sentinel events (Adamski, 2007; Patterson & Wears, 2010) . The different unit cultures and contexts and the resulting lack of collaboration and cohesion between nurses create increased risk for adverse events (Behara et al., 2005). An evidence based practice project was completed with a team of staff nurses from the ED and in-patient environments. Donabedian’s structure, process, and outcome framework was utilized. The unit culture and context and the differences in perceptions for the ED admission handovers were analyzed. Using information from a literature review, perception surveys, and a collaborative review of the existing ED admission handover process, the work resulted in seven recommendations for improvements. In addition, the nurses developed an appreciation for the challenges of the different work environments. Setting aside unit preferences and focusing on patient safety allowed the staff to develop consensus and cohesion for the process of the ED admission handover event. The recommendations are fiscally neutral and within the locus of control of the staff involved in the process.