Morning report: an Australian experience

Robert G Fassett and Steven J Bollipo
Med J Aust 2006; 184 (4): 159-161. || doi: 10.5694/j.1326-5377.2006.tb00175.x
Published online: 20 February 2006


  • In January 2001, a daily morning handover meeting (“morning report”), involving medical staff and students, began at the Launceston General Hospital, Tasmania.

  • Periodic questionnaire surveys have been conducted to assess whether the morning report is fulfilling the quality improvement and educational needs of medical staff. The format of meetings has been successively modified in response to feedback.

  • Participants have expressed a preference for patient-focused meetings, with less emphasis on formal teaching.

  • A 12-month pilot study beginning in January 2004 has assessed the impact of adding a bed-management focus to the morning report.

  • Over the period of the pilot study, there has been reduced bed access block, reduced average length of stay and increased bed availability. This suggests that a longer, more formal study may be warranted.

After-hours work in hospitals is sometimes indirectly supervised and not formally handed over to the day doctors. One way to monitor the quality of such work is to conduct a formal morning handover meeting (“morning report”). This can ensure continuity of care, provide a mutual learning experience for both after-hours and day medical staff, and give physicians the opportunity to assess the quality of after-hours work.

Morning report has been an important educational tool in most internal medicine training programs in the United States for many years.1-3 Most studies of morning report refer to the teaching and learning value of the meeting, but another benefit reported in one study was the enhancement of adverse-event reporting by prompting doctors at morning report.4

To the best of our knowledge, conducting morning report is not common practice in Australian hospitals, and published data are limited.5,6

Morning report was established as a quality improvement project in the Launceston General Hospital Department of Medicine in January 2001. Here, we detail our experience of establishing morning report, evaluating its contribution to quality improvement, and modifying the content of meetings in response to feedback from participants. We describe how the program has evolved through three different formats to reach its current form. In addition, from January to December 2004 we conducted a pilot study to assess the impact of introducing a bed-management focus into the morning report.

Format 1
Format 2
Format 3

The third and current format was implemented in January 2004. It is similar to the original format but with a stronger focus on punctuality, leadership, physician presence and patient-focused discussions. The Director of Medicine coordinates the meetings, and attendance by on-call physicians and representatives from all units is compulsory. An attendance sheet is maintained.

This format has become popular, with an average of eight consultants attending daily along with PGY1–PGY3 doctors and physician trainees.

Case presentations are made from photocopied or electronic notes, eliminating errors of recall. Complete, uninterrupted presentation of each case, including investigations, takes about 5 minutes. All photocopied notes are then handed over to the day staff at the end of the meeting.

A further change has been the implementation in January 2004 of a focus on bed management. A daily review is conducted of medical patients in surgical beds, and overall medical patient numbers are compared with available beds. Patient numbers per ward and the type of patient (ie, medical or surgical) are displayed on a whiteboard. When each patient is reviewed, a discharge plan is formulated. A daily emphasis on discharging has been promoted.

Change in practice has been brought about by:

  • actively accepting surgical patients who do not require an operation onto medical wards; and

  • actively promoting transfer of medical patients on surgical wards to medical beds the day after admission.


The evolution of morning handover meetings in our hospital highlights the difficult balance to be achieved between quality improvement and formal education. Morning report has changed the culture within our department, resulting in increased participation from physicians, greater supervision of after-hours work and improved educational value.

We agree with Nair and colleagues5 that morning report should be an essential part of training and patient care in internal medicine, and offer our tips for establishing, running and evaluating a morning report (Box 2). Further, we agree with Welsh and colleagues that morning report could be improved by recording and discussing adverse incidents.4

Introducing a focus on bed management during the morning report coincided with improvement in some measures of bed management. However, we acknowledge that bed management is a complex process and that other simultaneous changes could have influenced our findings. Furthermore, we assessed the potential effect over only a short period of time. A more comprehensive, prospective study of the impact of a bed management focus during morning report is required and is planned at our institution.

Our report lacks patient outcome data and comparisons with other hospitals in Australia, but these aspects are the subject of ongoing research in our department. We hope our report will encourage other Australian hospitals to relate their experience of morning handover meetings.

2 Tips for establishing, organising, running and evaluating morning report

Establishing meetings

  • Evaluate the existing handover procedure and recognise the need for improvement.

  • Get support from the Director of Medicine, the hospital administration and the quality improvement unit.

  • Allocate an hour for meetings and protect it from interruptions, ward rounds and conflicting meetings.


  • Choose a location within the department to maximise attendance.

  • Choose a room that is small enough to encourage active participation and personal interaction.

  • Make attendance compulsory for the on-call physician, physician trainee and Year 2 / Year 3 postgraduate doctors on night duty. Encourage all physicians to attend.

  • Provide facilities such as a television, video player, data projector, x-ray viewing box and whiteboard to encourage enhanced case presentations.

  • Provide coffee, tea and breakfast to create a friendly atmosphere and encourage social interaction.

Running a meeting

  • Insist on complete, accurate case presentations and discourage casual, brief presentations. A complete, uninterrupted presentation takes only 5 minutes.

  • Focus discussions on management of the patient in question.

  • Give positive feedback in public, saving any negative feedback to be discussed privately after the meeting. This avoids public humiliation, embarrassment or intimidation.

  • Start the meeting on time and finish early wherever possible. The chairperson should ensure the meeting does not extend unnecessarily.

  • Education should be a by-product of case discussions and not the primary focus.


  • Conduct periodic formal evaluation by questionnaire-based surveys.

  • Obtain ongoing informal feedback by involving the group in discussions about improvement of the handover process.

  • Implement changes in response to feedback to complete the quality improvement cycle.

  • Robert G Fassett1
  • Steven J Bollipo2

  • Department of Medicine, Launceston General Hospital, Launceston, TAS.


Competing interests:

None identified.

  • 1. Harris ED Jr. Morning report. Ann Intern Med 1993; 119: 430-431.
  • 2. Wenger NS, Shpiner RB. An analysis of morning report: implications for internal medicine education. Ann Intern Med 1993; 119: 395-399.
  • 3. Amin Z, Guajardo J, Wisniewski W, et al. Morning report: focus and methods over the past three decades. Acad Med 2000; 75 (10 Suppl): S1-S5.
  • 4. Welsh CH, Pedot R, Anderson RJ. Use of morning report to enhance adverse event detection. J Gen Intern Med 1996; 11: 454-460.
  • 5. Nair BR, Hensley MJ, Pickles RW, Fowler J. Morning report: essential part of training and patient care in internal medicine [letter]. Aust N Z J Med 1995; 25: 740.
  • 6. Carruthers A. General practitioner participation in ‘Morning Report’ at a major teaching hospital. Aust Fam Physician 1997; 26 Suppl 2: S96-S98.
  • 7. Australian Council on Healthcare Standards. Determining the potential to improve quality of care. 5th ed. Sydney: ACHS, 2004: 52. Available at: (accessed Jan 2006).


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