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J Surg Educ. 2015 May-Jun;72(3):402-9. doi: 10.1016/j.jsurg.2014.11.002. Epub 2014 Dec 9.

Establishing a conceptual framework for handoffs using communication theory.

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Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address:



A significant consequence of the 2003 Accreditation Council for Graduate Medical Education duty hour restrictions has been the dramatic increase in patient care handoffs. Ineffective handoffs have been identified as the third most common cause of medical error. However, research into health care handoffs lacks a unifying foundational structure. We sought to identify a conceptual framework that could be used to critically analyze handoffs.


A scholarly review focusing on communication theory as a possible conceptual framework for handoffs was conducted. A PubMed search of published handoff research was also performed, and the literature was analyzed and matched to the most relevant theory for health care handoff models.


The Shannon-Weaver Linear Model of Communication was identified as the most appropriate conceptual framework for health care handoffs. The Linear Model describes communication as a linear process. A source encodes a message into a signal, the signal is sent through a channel, and the signal is decoded back into a message at the destination, all in the presence of internal and external noise. The Linear Model identifies 3 separate instances in handoff communication where error occurs: the transmitter (message encoding), channel, and receiver (signal decoding).


The Linear Model of Communication is a suitable conceptual framework for handoff research and provides a structured approach for describing handoff variables. We propose the Linear Model should be used as a foundation for further research into interventions to improve health care handoffs.


Interpersonal and Communication Skills; Patient Care; Professionalism; communication; framework; handoffs; transition of care

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