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BMC Med Educ. 2017 Nov 15;17(1):213. doi: 10.1186/s12909-017-1067-0.

Am I getting an accurate picture: a tool to assess clinical handover in remote settings?

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Rural Clinical School, Australian National University Medical School, 54 Mills Rd, Acton, ACT, 2601, Australia.
Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, Australia.
Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
Rural Clinical School, University of Adelaide, Adelaide, Australia.
Medical School, University of Sheffield, Sheffield, UK.



Good clinical handover is critical to safe medical care. Little research has investigated handover in rural settings. In a remote setting where nurses and medical students give telephone handover to an aeromedical retrieval service, we developed a tool by which the receiving clinician might assess the handover; and investigated factors impacting on the reliability and validity of that assessment.


Researchers consulted with clinicians to develop an assessment tool, based on the ISBAR handover framework, combining validity evidence and the existing literature. The tool was applied 'live' by receiving clinicians and from recorded handovers by academic assessors. The tool's performance was analysed using generalisability theory. Receiving clinicians and assessors provided feedback.


Reliability for assessing a call was good (G = 0.73 with 4 assessments). The scale had a single factor structure with good internal consistency (Cronbach's alpha = 0.8). The group mean for the global score for nurses and students was 2.30 (SD 0.85) out of a maximum 3.0, with no difference between these sub-groups.


We have developed and evaluated a tool to assess high-stakes handover in a remote setting. It showed good reliability and was easy for working clinicians to use. Further investigation and use is warranted beyond this setting.


Clinical handover; Communication skills; Medical education; Work-based assessment

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