Abstract

Effective electronic handoffs ensure seamless patient transitions between the emergency department (ED) and medical-surgical units. This article examines common challenges associated with electronic handoff processes and proposes evidence-based strategies to optimize information transfer, improve patient safety, and enhance interdepartmental communication.

Introduction

Patient transfers between hospital units present a significant risk for communication errors and information gaps, potentially compromising patient safety. Structured communication tools have been shown to improve patient outcomes during intra-hospital transfers (Mueller et al., 2023). Electronic tools, integrated directly into the electronic medical record (EMR), offer a promising avenue for facilitating interprofessional handoffs from the ED to inpatient units, enhancing communication and reducing errors (Collins et al., 2011). Notably, EMR handoff reports, sometimes called SBAR reports, have demonstrated a reduction in ED boarding times and improved continuity of care (Aronson, 2021).

While these tools are increasingly available, their consistent adoption in standard handoff practice remains inconsistent (Staggers et al., 2012). Auto-generated EMR handoff reports may still result in information gaps despite relying on direct EMR data. Bridging the gap between EMR handoff reports and the patient's actual clinical status upon admission to medical-surgical units is essential for improving both communication and patient outcomes. Developing solutions for accurate and efficient handoffs requires a collaborative approach that considers the needs and resources of both ED and medical-surgical nurses.

Challenges of Electronic Handoffs

Information Overload and Incompleteness

Medical-surgical nurses often encounter an overwhelming volume of information within the EMR, hindering their ability to focus on the patient overview. This information overload, including extensive past medical and surgical histories, and detailed consultant notes can obscure critical information relevant to the patient's current condition. The time spent navigating this data detracts from direct patient care. Consequently, nurses may feel unprepared to provide safe and effective care due to incomplete or obscured information in EMR handoff reports. These communication deficiencies are associated with prolonged lengths of stay and increased mortality (Mueller et al., 2023). Refining EMR handoff reports is crucial to mitigate these communication inconsistencies.

Lack of Standardization and Usability

While EMR developers recognize the need for comprehensive handoff tools, current EMR-generated handoff reports often suffer from poor usability. Feedback from medical personnel highlights issues such as insufficient relevant information, excessive irrelevant data, and a lack of end-user customization (Aronson, 2021). There is a clear need to enhance the information provided while minimizing unnecessary content.

Digital Literacy Variations

Variations in digital literacy among nursing staff pose a challenge to the effective utilization of electronic handoff reports. Nurses with limited digital literacy may struggle to locate critical information within the EMR if it is not readily accessible in the handoff report. This difficulty navigating complex medical records can divert time from direct patient care.

Communication Gaps and Limited Clarification

Sole reliance on electronic handoffs can limit opportunities for real-time clarification. Despite the benefits of electronic documentation, discrepancies often exist between nurses' clinical experience and the auto-generated information in EMR handoff reports.

Strategies for Improvement

Development of Standardized Electronic Handoff Templates

Optimizing EMR handoff reports requires a collaborative effort between ED and medical-surgical nurses to create a template that meets the needs of both units. Implementing standardized practices, including mandatory review and updating of auto-generated handoff reports by ED nurses, is crucial to ensure the inclusion of essential information.

Optimized EHR Interface and Customization

Consulting medical-surgical nurses to identify their specific information needs and collaborating with information technology staff to modify the standard EMR handoff report is essential. Incorporating a free-text field within the handoff report will allow ED nurses to provide customized information, ensuring comprehensive communication.

Integration of Enhanced Communication Tools

Combining EMR handoff reports with real-time communication tools, such as secure messaging and chat features within the EMR, facilitates rapid clarification of incomplete information during patient transitions.

Comprehensive Education and Training

Providing comprehensive training programs on EMR navigation and handoff skills is essential. Educating nurses on the importance of accurate communication during patient transfers and emphasizing accountability for thorough information transfer can prevent adverse patient outcomes.

Regular Audits and Feedback Mechanisms

Regular audits and feedback from nursing staff evaluate the effectiveness of implemented strategies. Utilizing EMR data to assess handoff report usage and soliciting feedback from ED and medical-surgical nurses can help refine procedures and optimize handoff requirements.

Discussion

This article emphasizes the importance of optimizing electronic handoffs during patient transitions from the ED to medical-surgical units. The identified challenges, including information overload, lack of standardization, digital literacy variations, and communication gaps, highlight the struggles with communication evident during transfers. Implementing the proposed strategies, including standardized templates, optimized EHR interfaces, enhanced communication tools, and comprehensive training, represents a systematic approach to mitigating these issues. Collaboration between ED and medical-surgical nurses ensures that handoff processes meet the specific needs of both units. Continuous audits and feedback are crucial for ongoing evaluation and refinement.

Future research should focus on quantifying the impact of these interventions on patient outcomes, such as length of stay and adverse events, and exploring the potential of emerging technologies to further enhance handoff efficiency. Improving electronic handoffs requires sustained commitment to interprofessional collaboration and continuous improvement.

Conclusion

Effective electronic handoffs help to ensure patient safety and promote seamless transitions between the ED and medical-surgical units. By addressing the identified challenges and implementing standardized strategies, healthcare organizations can enhance communication and reduce the risk of adverse events. The key to successful optimization lies in collaborative design, ongoing evaluation, and a commitment to continuous improvement. As technology continues to evolve, healthcare institutions must continually adapt and refine their handoff processes to meet the ever-changing needs of patients and providers. By prioritizing clear communication and efficient
information transfer, we can ensure safer and more effective patient care during critical transition periods.

References

Aronson, T. (2021). Key characteristics of a successful EHR-supported e-handoff tool: A
systematic review: OJNI. Online Journal of Nursing Informatics, 25(1) Retrieved from https://www.proquest.com/docview/2622255354?sourcetype=Scholarly%20Journals

Browning, L., Raza-Khan, U., Leggat, S., Boyd, J. H., & Sirwan Khalid Ahmed. (2025). The Impact of Electronic Medical Record Implementation on the Process and Outcomes of Nursing Handover: A Rapid Evidence Assessment. Journal of Nursing Management, 2025(1). https://doi.org/10.1155/jonm/5585723

Collins, S. A., Stein, D. M., Vawdrey, D. K., Stetson, P. D., & Bakken, S. (2011). Content overlap in nurse and physician handoff artifacts and the potential role of electronic health records: A systematic review. Journal of Biomedical Informatics, 44(4), 704–712. https://doi.org/10.1016/j.jbi.2011.01.013

Mueller, S., Murray, M., Goralnick, E., Kelly, C., Fiskio, J. M., Yoon, C., & Schnipper, J. L. (2023). Implementation of a standardised accept note to improve communication during inter-hospital transfer: A prospective cohort study. BMJ Open Quality, 12(4). https://doi.org/10.1136/bmjoq-2023-002518

Staggers, N., Clark, L., Blaz, J. W., & Kapsandoy, S. (2012). Nurses’ information management and use of electronic tools during acute care handoffs. Western Journal of Nursing Research, 34(2), 153–173. https://doi.org/10.1177/0193945911407089