Clinical handover, often referred to as patient handoff, remains one of the most critical yet persistently vulnerable processes in modern healthcare systems. It represents the point where continuity of care depends entirely on the accuracy, clarity, and completeness of interprofessional communication. Despite substantial attention over the last two decades, handover practices continue to be associated with communication failures, incomplete information transfer, and preventable adverse events (Desmedt et al., 2021; Rosenthal et al., 2018). While structured communication tools such as SBAR, ISBAR, and I-PASS have been widely implemented, their actual impact on clinical outcomes remains inconsistent, revealing a gap between procedural compliance and meaningful patient safety improvement (Mueller et al., 2018; Ryan et al., 2024).
Moreover, the handover process embodies a complex intersection of cognitive, social, and organizational dynamics. Its effectiveness is influenced by time constraints, human factors, institutional culture, and the integration of digital documentation systems (Manser, 2013; Browning et al., 2025). Emerging technologies—such as electronic medical records (EMR), health information exchange (HIE), and artificial intelligence (AI)—offer new possibilities for standardizing information exchange but simultaneously raise concerns regarding usability, workflow disruption, and cognitive load. In this context, it becomes crucial not only to synthesize what is known about handover practices but also to identify where the field continues to struggle in translating evidence into practice.
After reviewing 62 systematic and scoping reviews published in the last decade, this paper aims to consolidate the research gaps, persistent challenges, and emerging opportunities within the patient handover literature. The goal is to map where consensus exists, where contradictions persist, and where future research can most productively contribute to the science of safe and effective care transitions.
Methods: This review was conducted in accordance with established guidelines for scoping and systematic literature reviews in healthcare. The Web of Science Core Collection was used to retrieve relevant articles. A title-level search was executed using the Boolean string: “hand off” OR “handoff” OR “hand over” OR “handover”. To ensure relevance to patient outcomes and safety in clinical transitions, results were refined using three filters:
- Search within all fields: Patient Safety
- Document type: Review Article
- Language: English
This strategy yielded 62 review articles addressing various aspects of clinical handovers across care settings. Keywords such as “clinical handover,” “bedside handover,” “patient handoff,” and “SBAR” were manually explored for contextual relevance.
Studies were included if they:
- Focused on healthcare settings (inpatient, emergency, surgical, or critical care),
- Described or evaluated handover processes, tools, or models,
- Reported on safety, process quality, or patient outcome indicators.
The analysis focused on methodological characteristics (study design, inclusion criteria, and frameworks used), types of handover assessed (verbal, written, electronic, hybrid), intervention components (mnemonics, standardization tools, patient inclusion), and reported outcomes (e.g., mortality, readmissions, satisfaction, fidelity, sustainability). Meta-analyses, where available, were noted, but most data synthesis was narrative due to intervention heterogeneity. To identify conceptual and methodological gaps, the included articles were further categorized by clinical setting, type of handoff, type of intervention, and evidence quality. Results were integrated to construct a future research agenda aligned with patient safety, implementation science, and context-sensitive design.
Results: The true impact of patient handovers on patient outcomes remains uncertain. Systematic reviews report that standardized tools improve process metrics (e.g., information completeness, duration, satisfaction), but fail to produce consistent and strong effects on patient outcomes such as mortality, complications, or readmissions. Claims of improvement, including those for SBAR implementation, are often modest and confounded by design heterogeneity, limiting the feasibility of meta-analysis and yielding inconsistent effect sizes (Mueller et al., 2018; Mardis et al., 2017; Rosenthal et al., 2018; Desmedt et al., 2021). A Cochrane review on the effectiveness of nursing handover styles emphasized that no conclusions could be drawn due to the absence of RCTs, leaving the question of “which model improves patient outcomes” unanswered (Smeulers et al., 2014). Similarly, while retrospective studies suggest increased risks in intraoperative handovers, generalizability is limited as data pooling is not feasible (Abraham et al., 2021).
Metrics, classification, and terminology are fragmented. Studies measure dozens of different process, team, and patient outputs; a common core outcome set is absent. This situation undermines both synthesis and comparability (Robertson et al., 2014; Odone et al., 2022). Although a comprehensive list of mnemonics exists, a taxonomic framework for their functional components is only just emerging, and consensus in the field is lacking (Yung et al., 2023). A recent review on daily surgical handover proposed a new taxonomy for interventions and outcomes, yet the methodological maturity and quality scores of the included studies remain low (Ryan et al., 2024).
The tension between standardization and contextual adaptation remains unresolved. Guideline-compliant, structured forms and checklists can enhance information transfer; however, “one size does not fit all.” Local workflows, unit dynamics, and interdisciplinary roles can cause the same tool to succeed in one institution and fail in another (Pucher et al., 2015; Møller et al., 2013). In ED or EMS-ED handovers, cultural and organizational factors, along with interprofessional perceptual differences, render standardization insufficient on its own (Jensen et al., 2013). While liaison nurses and structured forms are promising for ICU-to-ward transitions, the effects remain inconsistent without context-sensitive design (van Sluisveld et al., 2015; Wibrandt & Lippert, 2020).
The risk-benefit balance of patient and family engagement remains controversial. Bedside handover can enhance safety-related information verification, satisfaction, and participation; however, privacy concerns, the management of clinically inappropriate content, and nurse apprehensions are persistent barriers (Tobiano et al., 2018, 2019; Bressan et al., 2019). Recent reviews report that patient-centered handover can also contribute to organizational efficiency, yet implementation adherence and workload perceptions may decline over time, creating a sustainability problem (Daicampi et al., 2025; Maher et al., 2025).
Evidence for interdisciplinary models is weak and fragmented. Systematic reviews on physician-nurse handover indicate that different models are evaluated using 44 distinct metrics; while improvements in process and professional outcomes may occur, there is no robust evidence or common metrics to determine which model is superior (Odone et al., 2022). Gaps in best practices for specific pediatric subgroups and evidence shortages in ED-PICU transfers persist (Foronda et al., 2016).
The risks of perioperative and intraoperative handover are known, but solutions are inadequately tested. Observational data suggests a link between intraoperative handovers and adverse outcomes, yet most tool-based studies only improve process metrics; effects on clinical outcomes remain unclear (Abraham et al., 2021). While SBAR/ISBAR appears to be a relatively mature framework in PACU handovers, a uniform standard is lacking, and validation and feasibility studies are deficient (Wang et al., 2021; Møller et al., 2013). The vision for perioperative “smart handovers” and artificial intelligence integration remains largely conceptual; real-world impacts have not been evaluated (Sparling et al., 2023).
Educational interventions lack theoretical grounding and high-level outcomes. Handover education is often limited to simulation, role-playing, and single-patient exercises; the majority of studies remain at Kirkpatrick levels 1–2, reporting of educational theories and pedagogical design is weak, and patient impacts are rarely measured (Gordon & Findley, 2011; Gordon et al., 2018). Even in anesthesiology handover education, curriculum objectives, theoretical citations, and assessment maturity are low; despite this, changes in practice behavior are reported, though patient outcomes are monitored in a limited number of studies (Riesenberg et al., 2023). While education appears beneficial for student nurses, effects are heterogeneous and lack practice experience (Le et al., 2023; Malone et al., 2016). Informal learning programs also suffer from a lack of theoretical transparency and monitoring of patient outcomes (Boje & Ludvigsen, 2020).
Digital solutions are promising but lack user experience and co-design. Although EMR and e-handover approaches have the potential to increase safety, nurses frequently prefer printed, customized forms; EMR interfaces are found to increase cognitive load, and content is often perceived as irrelevant and cumbersome (Matic et al., 2011; Browning et al., 2025). While workflow integration facilitates HIE adoption in long-term care, organizational culture remains the largest barrier (Kruse et al., 2018). Conversely, there are examples of electronic templates demonstrating sustainable benefits over years in specific surgical units; however, generalizability and side effects must be studied better (Lightsey et al., 2023).
A paradox exists: an abundance of mnemonics and tools, yet a scarcity of evidence. While SBAR/ISBAR are the most frequently cited frameworks, few small-sample studies directly test the effectiveness of mnemonics; convincing evidence of their comparative superiority has not been produced (Riesenberg et al., 2009, 2019). A framework tagging 42 mnemonics by their functions provides a basis for which information elements are safety-critical; still, prospective evidence linking them to clinical outcomes is scarce (Yung et al., 2023).
In prehospital-ED and emergency patient handovers, educational, operational, cultural, and cognitive barriers cluster. Lack of respect/attention, environmental distractions, goal conflicts, and absence of standardization are common themes; while technological and educational solutions are proposed, the evidence is qualitative and heterogeneous (Troyer & Brady, 2020; Dawson et al., 2013). The gap between actual practice and recommendations in the handover of critically ill patients between emergency departments remains a serious safety concern (Tortosa-Alted et al., 2021).
The dimensions of implementation science, fidelity, and sustainability are understudied. Multi-center, long-term studies monitoring fidelity-impact relationships in real-world settings are rarely reported. Although change management approaches are suggested, the performance indicators and feedback loops necessary for institutionalizing and monitoring practices are not systematic (Clarke & Persaud, 2011; Desmedt et al., 2021). While some electronic templates may maintain benefits over years, declining adherence over time is a frequently encountered risk (Lightsey et al., 2023; Maher et al., 2025).
Methodological maturity and evidence quality are generally insufficient. Most studies are single-center pre-post designs; multi-component interventions are introduced simultaneously without control groups, making it impossible to distinguish the contribution of each component (Robertson et al., 2014; Ryan et al., 2024). The focus of human factors research on episodic handovers risks scientifically reproducing the very fragmentation of care it studies; patient-centered designs that view the dependencies of sequential handovers across the care journey are lacking (Manser, 2013).
Gaps in equity, language, and contextual generalizability are prominent. Studies are predominantly from Anglophone contexts; data on handover design and impact in low- and middle-income countries (LMICs), rural areas, and populations with varying language and health literacy levels is limited. The cost-effectiveness and scalability of new roles (e.g., liaison nurse) have not been tested according to context (Wibrandt & Lippert, 2020; van Sluisveld et al., 2015). The search for a balance between privacy and participation may yield different outcomes across cultures, an area where comparative data is non-existent (Tobiano et al., 2019; Forde et al., 2018).
The future research agenda necessitates core outcome sets and comparative designs. Priority gaps could be filled by: multi-center, cluster randomized trials or realist evaluations testing context-mechanism-outcome chains; studies using common metrics (core sets) at the patient, team, and system levels; objectification of process quality using digital footprint data; cost-effectiveness analyses; and long-term sustainability studies (Ryan et al., 2024; Rosenthal et al., 2018). Hybrid effectiveness-implementation studies—measuring co-design, cognitive load, usability, and safety culture impacts simultaneously—should also be a priority for EMR/HIE/AI solutions (Browning et al., 2025; Sparling et al., 2023; Kruse et al., 2018).
Conclusion: This review of 62 systematic and scoping reviews clarifies that patient handover is simultaneously ubiquitous and under-standardized: most interventions improve information transfer and staff perceptions, yet consistent gains in patient outcomes remain elusive due to heterogeneous measures, short follow-up, weak study designs, and context insensitivity. Advancing the field requires a common outcomes core set spanning patient, process, team, and system levels; stronger designs (cluster trials, stepped-wedge, and realist/hybrid effectiveness–implementation studies); and longitudinal assessment of fidelity, sustainability, and unintended effects. Equally important are taxonomy harmonization across mnemonics and settings, theory-informed education evaluated beyond Kirkpatrick levels 1–2, and rigorous, usability-tested digital solutions that reduce cognitive load rather than add to it.
Future work should prioritize context-aware standardization (not one-size-fits-all), patient and caregiver participation at the bedside with explicit privacy safeguards, and equity- and cost-effectiveness analyses to ensure scalable adoption across diverse health systems, including LMICs. A coordinated agenda around these elements offers the most credible path to converting procedural compliance into measurable improvements in safety, efficiency, and patient experience.
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