To the Editor: I was not surprised by the results published by Fassett et al1 regarding clinical handover. Despite being a crucial part of health care, clinical handover has only recently become a topical issue in the clinical governance arena.

In May 2007, the World Health Organization launched the “Nine patient safety solutions” to “help reduce the toll of health care-related harm affecting millions of patients worldwide”.2 Solution number three relates to “communication during patient hand-overs”. Australia is in fact leading the international collaboration on clinical handover through the National Clinical Handover Initiative. This was recently launched by the Australian Commission on Safety and Quality in Health Care to develop and implement standardised solutions to patient safety problems associated with clinical handover.3

At a state level, the Victorian Quality Council conducted a clinical handover survey of Victorian health services in May 2006 to provide an overview of areas of concern relating to clinical handover.4 The Council launched a pilot project in 2007 to look at morning handover processes between junior doctors. Despite these efforts, hospitals are still struggling with the issue of clinical handover at the local level. All health professionals know that clinical handover is good clinical practice, but they need to be provided with the tools to carry it out properly.

Clinical handover, depending on your definition, includes referral letters from general practitioners, discharge summaries from hospitals, as well as handover of clinical information between different shifts, treating teams, wards, health professionals and health services. It makes sense that the process of handover of clinical information be carried out in a standardised format, as the minimum dataset required is consistent for most circumstances. While there is a need for standardisation, health organisations must also be able to devise local innovative solutions that work for them. Information technology can assist in developing a solution to this issue. For example, different local health services have already developed in-house systems for electronic discharge summaries that are integrated with an electronic health record. While national quality bodies endeavour to develop national standards and tools for clinical handover, local health services must not sit idly and wait for these, but must continue to innovate and provide workable local solutions for their own health professionals. Otherwise, future surveys of clinical handover will continue to show that a problem still exists in relation to this issue.

In reply: Our national survey was specifically confined to medical morning handover report, one of many forms of clinical handover.1 The clinical governance area may have only recently recognised the importance of clinical handover, but it has been a topical issue for many years in the clinical arena, particularly in the United States.2 While Australia may be leading the way in international collaborations, our survey suggests that this is not translating into clinical practice. Rather than commissions and councils providing tools and guidelines to carry out clinical handover, clinical leaders need to participate and conduct clinical handover themselves at the local level. From our previous experience with morning report, we provided simple tips on how to implement clinical handover at the local level,3 and these have been incorporated into Australian Medical Association guidelines.4

Information technology can be employed to help with the clinical handover process. However, when using the all-inclusive definition of clinical handover suggested by Loh, this task is complex, as research has shown that information management needs vary significantly between different clinical environments and would require multiple end-user-defined outputs from a standardised data repository.5,6

Clinical handover needs to be implemented from the bottom up (by clinicians) rather than from the top down (by commissions).