ABSTRACT Handover, or the communication of patient information be.docx

ABSTRACT: Handover, or the communication of patient
information between clinicians, is a fundamental component of
health care. Psychiatric settings are dynamic environments
relying on timely and accurate communication to plan care and
manage risk. Crisis assessment and treatment teams are the
primary interface between community and mental health
services in many Australian and international health services,
facilitating access to assessment, treatment, and admission to
hospital. No previous research has investigated the handover
between crisis assessment and treatment teams and inpatient
psychiatric units, despite the importance of handover to care
planning. The aim of the present study was to identify the
nature and types of information transferred during these
handovers, and to explore how these guides initial care
planning. An observational, exploratory study design was used.
A 20-item handover observation tool was used to observe 19
occasions of handover. A prospective audit was undertaken on
clinical documentation arising from the admission. Clinical
information, including psychiatric history and mental state,
were handed over consistently; however, information about
consumer preferences was reported less consistently. The
present study identified a lack of attention to consumer
preferences at handover, despite the current focus on recovery-
oriented models for mental health care, and the centrality of
respecting consumer preferences within the recovery paradigm.
INTRODUCTION Handover is the transfer of verbal and written
communication of patient information between members of the
health-care team. It is integral to the practice of all healthcare
clinicians (Millar & Sands 2012). The Australian Commission
for Safety and Quality in Health Care (ACSQHC 2011)
recognizes the importance of handover in the continuum of
health care, and acknowledges that information transferred
between clinicians during the handover can directly affect the

quality of care delivered to patients. Poor-quality handover
practice has been linked to a number of unfavourable patient
outcomes, including increased hospital stays, consumer
dissatisfaction, delays in treatment, and other adverse clinical
outcomes (Hill & Nyce 2010; Manser & Foster 2011; Siemsen et
al. 2012; World Health Organization Collaborating Centre for
Patient Safety
Solution
s (WHOCCPSS) 2007). In the present study, we report on the
findings of a study that investigated handover between the crisis
assessment and treatment team (CATT) and the inpatient
psychiatric unit (IPU).
There is little in the published literature that reports on
handover practices in acute psychiatric settings, and no previous
research that has specifically investigated handover between the
CATT and the IPU. The lack of studies in this area is
concerning, given that in Australia and internationally, CATT
service models are in wide use to facilitate community access to
psychiatric assessment and care for people who are experiencing
acute mental health crises and associated risks of harm (Cotton
et al. 2007; Hasselberg et al. 2011a,b; Johnson 2013). The
initial assessment information attained by CATT is critical to
guiding safe, high-quality consumer care (Singh et al. 2012),

yet little is known about what types of information are
communicated by CATT to the IPU, the way in which this
information is transferred, or how this is used to guide care
planning and interventions in the IPU. The CATT provides
services for people with mental illness who are in psychiatric
crisis in the community (Carroll et al. 2001; Hasselberg et al.
2011a; Johnson 2013, 2004; Singh et al. 2012; Victorian
Government 2007). Psychiatric crises are characterized by acute
disturbances of mental state and behaviour, and are associated
with significant risks (Oliva & Compton 2008). Consumers
experiencing acute psychiatric crises in the community are a
vulnerable group, requiring timely intervention to ensure
appropriate management of risks and assertive treatment for
their condition (Carroll et al. 2001; Singh et al. 2012; Victorian
Government 2007). Safe, effective management of consumers
transferred from the community to an IPU requires a specialized
team of multidisciplinary mental health clinicians working
collaboratively to ensure the consumer receives quality care in a
safe environment (Cotton et al. 2007; Deacon et al. 2006; Jones
2006; Singh et al. 2012). New South Wales Health (NSW Health
2012) recognizes the transfer of consumers from the community
to the IPU as a highrisk process, and developed a policy to
inform this procedure. One of the major principles stipulated
throughout this policy is the importance of accurate and timely
handover communication, particularly the accurate transfer of

risk information. Communication failures are one of the main
reasons for the occurrence of sentinel events in health care
(WHOCCPSS 2007). The current emphasis on holistic patient
care has resulted in health-care settings evolving into dynamic,
multifaceted environments, where entire teams of
multidisciplinary clinicians are directly or indirectly involved
with a patient’s care (Bowers et al. 2009; Deacon & Cleary
2012). The importance of effective communication in acute
psychiatric settings cannot be understated; communication
failures can lead to inadequate treatment outcomes, but can also
place clinicians at significant risk of assault and injury (Kuehn
2010). Consumers presenting in psychiatric crisis require care
that is cognizant of their risks as a means of promoting
consumer and clinician safety (Sands et al. 2012). In an
observational study examining risk communication at handover
on an IPU, Millar and Sands (2012) found that risk information
was often inconsistently communicated. They emphasized the
need for consistency and accuracy in the transfer of information
during handover, noting the strong link to consumer and
clinician safety, as well as more favourable care outcomes
(Millar & Sands 2012). In a study examining care transfers from
the emergency department to medical wards, Horwitz et al.
(2009, p. 701) used the phrase ‘dropping the baton’ to describe
breakdowns in communication between multiple stakeholders,
adding that communication breakdowns can lead to significant

treatment errors and care disruptions. Studies examining
emergency patient transfers identify different communication
styles between clinicians, poor retention of information, and
multiple interruptions as contributing to poor-quality handover
(Bost et al. 2012; Evans et al. 2010; Owen et al. 2009). A
number of recent studies examining handover practices in a
variety of generalist clinical settings have recommended the use
of structured handover tools, such as ‘ISBAR’ (Identify,
Situation, Background, Assessment and Recommendation) or
ISOBAR (Identify, Situation, Observation, Background, Action,
Response), in order to improve the quality and consistency of
handover practice (Bost et al. 2012; Millar & Sands 2012; Owen
et al. 2009; Quin et al. 2009; Yee et al. 2009). Very few studies
have examined the use of structured handover tools in
psychiatric settings (Hunt et al. 2012; Poh et al. 2013), or
handover practices in specialized mental health settings, such as
CATT. The primary aim and focus of the present study was to
identify and articulate the types of information communicated
in the CATT to IPU handover, and the practices and processes
used in information transfer. A secondary aim of the study was
to explore care planning and interventions arising directly from
information transferred in the handover. MATERIALS AND
METHODS This study employed an exploratory, descriptive
design using an observational method. Nineteen structured
observations of CATT to IPU handover were undertaken. All

clinical documentation related to the handover completed within
24 hours of the consumer’s admission was audited prospectively
for information relevant to the handover, and evidence of care
planning and interventions arising directly from handover
information. Setting The study was conducted at a major
tertiary referral hospital in metropolitan Melbourne, Australia.
The observations of handover were undertaken on one IPU,
which comprised of 22 low-dependency beds and six
highdependency beds. Participants The study involved
observations of CATT and IPU staff undertaking handover. The
CATT is comprised of nursing, medical, and allied health staff
who provide community-based psychiatric assessment and early
treatment. A multidisciplinary team of medical, nursing and
allied health clinicians staffs the IPU. Information sessions
were held for CATT and IPU staff to explain the purpose of the
research project. An information flyer explaining the project
was left onsite in the staff offices, along with packages
containing the participant information and consent form, and
instructions for returning signed consent forms. Ethical
considerations The hospital and university Human Research and
Ethics Committee granted ethical approval to conduct the
research. A waiver of consent was sought for the use of patient
information for the purposes of the documentation audit, as per
the National Statement on Ethical Conduct in Human Research
(NHMRC 2007). Instrumentation A handover observation tool

(Millar & Sands 2012), developed in a previous study
examining IPU handover, was adapted for use in this study. The
tool includes sections to record handover information
communicated verbally and in writing, and whether this
information was transferred into the consumer’s medical
records. Consistent with the original tool, items such as the
consumer’s age, diagnosis, sex, risk history, risk management
plan, and mental state, were included, and three additional items
were added to record psychiatric history, social status, and care
planning outcomes arising from the handover. A separate
section was added to the handover observation tool to record
qualitative field notes taken at the time of handover. The
original tool was pilot tested by Millar and Sands (2012), and
the modified version of the tool was tested again in this study
on the first three handovers observed. The tool was determined
to be appropriate for collecting the data for this project. Data
collection Data were collected between April 2013 and August
2013. At the commencement of each handover, the researcher
first confirmed that clinicians involved in the handover had
provided written consent to participate in the study. The
researcher then observed the handover and recorded the
observations into the data-collection tool. Following the
observation of the handover, all related clinical documentation
for the following 24 hours was reviewed to verify which
information communicated at the handover had been

documented in the patient records, and to identify any care
planning or interventions arising from the handover. Qualitative
field notes were also taken at the time of handover to document
any information pertinent to the handover not captured by the
handover observation tool; for example, interruptions and their
impact on handover, the handover environment, and
descriptions of the handover process. Data analysis Standard
descriptive statistical analysis was performed on the
quantitative data to calculate frequencies and percentages. All
qualitative field note data collected during the structured
observations were analysed using content analysis method
(Krippendorf 2004). Content analysis provides a structured
framework for analysing qualitative data. Using this method,
key words and phrases are systematically analysed (frequency,
repetition) to identify patterns and reoccurring themes in the
data (Hsieh & Shannon 2005). A second researcher was then
used to verify the themes generated from this iterative process.
RESULTS Nineteen observations of the CATT to IPU handover
were undertaken during the data-collection period from April to
August 2013. A total of six CATT clinicians and 14 IPU staff
participated in the study. All participants were registered or
enrolled nurses with 3 months–30 years of clinical experience in
psychiatry. Admissions were categorized according to which
CATT service had initially assessed and admitted the consumer.
The majority (63%, n = 12) of consumers were admitted via

emergency department CATT (ECATT). The admissions were
then further categorized into Section 9 involuntary admissions
(recommended under the Victorian Mental Health Act 1986;
Victorian Government 1986) and voluntary admissions. The
majority of consumers were admitted as involuntary patients
under Section 9. ECATT admitted 77% (n = 10) of involuntary
patients, as compared to CATT who admitted 23% (n = 3) of
involuntary patients. Basic demographic data were collected on
the consumer population. A summary of findings of the CATT
to IPU handover is reported in Table 1. There were close to
equal numbers of males 53% (n = 10) and females 47% (n = 9)
admitted during the data-collection period. The consumers’ ages
ranged from 18 years to 46 years, with the majority of
consumers in the 35–44-year age range. While a variety of
different psychiatric diagnoses were identified within the
consumer population, the most common diagnosis was
schizophrenia (32%, n = 6), followed by first-episode psychosis
(26%, n = 5) and borderline personality disorder (16%, n = 3).
Content of verbal handover The results showed that the
consumers’ psychiatric history (100%, n = 19), mental state
(100%, n = 19), and care instructions (100%, n = 19) were
consistently communicated during each occasion of handover.
The consumers’ risk history and social status were mostly
communicated during handovers (84%, n = 16). Consumer

preferences were less frequently communicated in 53% (n = 10)
of handovers. Handover documentation audit Following the
observation of handover, all clinical documentation produced
within 24 hours of admission was reviewed to verify the types
of information transferred from handover to patient medical
records. Five types of documentation suites were identified as
containing information reported at handover; the risk-
assessment document; the Initial Nursing Assessment Tool
(INAT), which is the main tool used for formulating an initial
nursing care plan and includes the consumer’s contacts details,
community supports, and care preferences; the nursing
admission notes; the CATT documentation and ‘power chart’;
the electronic health record; and the database for clinical
documentation accessible to all staff within the health service.
The results of the documentation audit indicated consistent
transferal of verbal handover information to the clinical
documentation, and high levels of adherence with
documentation. Consumer preferences are entered in the nursing
admission file entry, as well as in the INAT. The INAT was
considered complete if all documentation had been completed
and an initial nursing care plan had been formulated within 24
hours of admission. The audit indicated that in almost half of
the admissions (42%, n = 8), the section specifying the
consumers’ preferences for care was left blank or incomplete.
Care-planning outcomes The most common care outcomes

arising directly from the handover were the designation of low-
dependency units (LDU)/high-dependency units (HDU) (84%, n
= 16) and the administration of pro re nata (PRN) medications
(79%, n = 15). Consumer preferences were facilitated in 53% (n
= 10) of cases, and the use of seclusion or restraints arising
from handover information was minimal (11%, n = 2).
Observations derived from qualitative field notes Field notes
were taken at that time of the handover observation to describe
events or issues that might have impacted on the conduct of the
handover. Three important themes emerged from the content
analysis of the field notes data: the handover environment,
staffing profile, and the consideration of consumer preferences.
The setting for handover was a medium-sized communal staff
area with multiple access points. The handover room is enclosed
on all sides by windows, giving a fish bowl-type effect. At any
given time, the handover area could contain up to 20 nurses,
doctors, allied health staff, and administration personnel in this
confined space, with multiple conversations occurring
simultaneously. The researcher observed that the room was
extremely busy and crowded during nursing shift change (from
the morning to the afternoon), where for approximately 2 hours,
nursing staff numbers doubled. The following excerpt from the
field notes reflects the challenges of receiving handover within
this setting during nursing shift changeover. Nursing shift
change, many people in the room. AM staff is giving individual

handovers to PM staff. There is nowhere for CATT to sit to give
handover. Many conversations are taking place right now, very
difficult to hear what is being said. The CATT clinician is
speaking very quickly, the nurse is writing information down,
but how much of it can they hear? The most commonly-
observed handover practice was for the CATT clinician to
deliver handover to the IPU nurse in a continuous stream,
without the use of a structured handover tool, such as the
ISOBAR, to guide the conduct of the handover (Yee et al.
2009). The handover from CATT to the IPU nurse accepting the
transfer of care was generally no more than 5 minutes from start
to finish. However, prior to the CATT clinician’s arrival, the
CATT had already provided a brief telephone handover to the
nursing shift leader who would transcribe the information being
transferred onto loose-leaf paper. The nursing shift leader
would then provide a brief verbal handover and give the loose-
leaf sheet to the nurse accepting the admission. These multiple
points of communication meant that by the time the CATT
clinician arrived with the incoming consumer, the nurse
accepting the transfer of care usually had a reasonable second-
hand account of what was to be expected during the handover.
On several occasions, the consumers being admitted to the unit
were well-known to staff. Handover for ‘wellknown’ patients
was typically brief, and usually incorporated a reference to the
clinicians’ familiarity with the consumer. There was an

expectation from the clinician handing over that the consumer
should be well-known, and therefore, little historical
information was provided, as the following extract from the
field notes illustrates: CATT clinician began handover by
saying, ‘OK, introducing our good friend, Mr. X, very well-
known to XXX Psych, we all know this young man. He left us 2
weeks ago, didn’t show up for his depot, and here we are!’. The
skill mix of clinicians working on the IPU was observed to be
diverse; however, a significant proportion of the IPU nurses
were observed to be junior staff working under the guidance and
mentorship of senior staff. An important observation to arise
from the study was that junior staff members were less likely to
comment and ask CATT clinicians questions about the consumer
during the handover than experienced staff. This was
highlighted during one of the observations where the receiving
nurse was very experienced and requested detailed consumer
information in order to formulate a plan of care, as the
following field note excerpt illustrates: The consumer is a high-
aggression risk with a history of assault, and has been
recommended for HDU. The nurse receiving handover is very
experienced and asked many questions, such as ‘Does the
consumer have a drug and alcohol history?’, ‘What sets this guy
off?’, ‘Is there a history of mental illness in the family?’ The
CATT clinician had to check the file several times to answer all
his questions. The participation of the nursing shift leader was

also observed to be disruptive to the delivery of the handover.
The nursing shift leader was subject to continuous interruptions,
which resulted in a fragmented handover: The handover has
been interrupted twice due to the shift leader being needed by
ward staff and to speak to the bed manager on the phone. After
the second interruption, the shift leader didn’t return, and the
CATT clinician said they didn’t have time to wait around, plus
the consumer was agitated and needed medication, so they just
kept going. Consumer preferences As previously noted,
consumer preferences were communicated by the CATT to the
IPU staff in approximately half of the handovers observed. The
consumer preferences most frequently transferred at handover
included requests for particular foods, telephone access to call
family members, and requests for a single room versus a shared
room. The following field note excerpt describes an occasion of
handover where consumer preferences were transferred: Male
consumer received under Section 9, no fixed address. He has no
family or community supports, identifies a pigeon as being his
only friend. He was happy to come into hospital until the CATT
clinician opened up his suitcase and saw that he had packed a
decomposing pigeon that had died earlier in the week. The
CATT clinician told him that he would need to dispose of the
pigeon, at which point the consumer became distressed and
refused to be admitted. The CATT then agreed that the
consumer could bring the pigeon to hospital and bury it in the

ward’s courtyard, which the consumer agreed to. The
information about the pigeon was communicated verbally to IPU
staff, recorded in the documentation, and this consumer
preference was acted on according to the agreement made with
the consumer. DISCUSSION The present study found that
neither CATT nor IPU staff utilized structured handover tools
when delivering or receiving handover, despite the hospital
guidelines for handover practice stipulating the use of ISBAR
for handover. Although CATT and IPU clinicians were not
observed to use handover tools, certain information types were
consistently transferred across all of the handovers observed.
Key clinical information, such as the consumer’s psychiatric
history, mental state, risk history, social status, and care
instructions, was consistently communicated at handover.
Contrary to these findings, Millar and Sands’s (2012) study
found that the risk information was communicated
inconsistently, especially during the handover of consumers
deemed to be ‘high-risk’ consumers. It is difficult to compare
these findings in any meaningful way, due to the small sample
size of the present study and the highly specific nature of the
CATT to IPU handover, as compared to the routine shift-to-shift
handover examined in Millar and Sands’s (2012) study.
Consumer preferences were only reported in 53% of handovers
in this study, despite clear expectations from the health
organization for this to be completed in the INAT. Respecting

consumer preferences and choices is a key theme of current
Australian safety and quality literature (ACSQHC 2011), and
this worldview is articulated in Standard 3 of the National
Standards for Mental Health Services, Consumer and Carer
Participation (Australian Government 2010). The notion of
‘consumer participation’ exemplifies person-centred care, where
the needs, wishes, and goals of the person/consumer are used to
tailor individualized care that addresses the holistic and unique
needs of the consumer (Australian Government 2010; Fisher &
Happell 2009; Frese III et al. 2001). Person-centred approaches
to consumer care are also consistent with recovery-focused
approaches to mental health care, which highlight the
importance of being guided by consumer preferences, goals, and
hopes in care planning (Fisher & Happell 2009). In the new
paradigm of recovery-focused mental health care, a potential
solution to the failure to adequately report consumer
preferences at handover might be to actively involve consumers
in the handover. This approach is also consistent with Standard
6 of the Handover Safety and Quality Improvement Guide,
which states that the effectiveness of handover can be improved
with active consumer participation (ACSQHC 2012). To date,
no research has investigated the active participation of mental
health consumers in handover. A factor that might have
impacted on the consistency of reporting of consumer
preferences was the acuity of consumers being handed over. It

is possible that the consumers handed over in the present study
were unable to articulate their preferences for care as a result of
being acutely unwell. In a study investigating serviceuser
perceptions of telephone-based mental health triage, Elsom et
al. (2013) found low levels of serviceusers’ involvement in
decision-making, and that few service-users reported being
asked about their preferences. Elsom et al. (2013) observed
variations in the extent to which consumers in crisis want to, or
feel able to, be involved in their care when experiencing
psychiatric crisis. Scheyett et al. (2007) observed that during
times of psychiatric crisis, consumers receiving treatment can
experience a loss of autonomy and choices, resulting in
potentially traumatic experiences and a reluctance to engage in
future treatment. Tanenbaum (2008) found that consumers with
mental illness value having a range of different treatment
choices presented to them, and that the effectiveness of
evidence-based interventions sometimes mattered less than
being offered a choice. Fisher and Happell (2009, p. 182) echo
this by stating: ‘If evidence-based practice does not take
account of the human aspect of treatment, then it is not genuine
recovery-oriented treatment’. Observations of handover in this
study suggest that familiarity with the consumer might
influence the duration and quality of the handover, a theme
echoed in a study examining the practices of handover in a
psychiatric rehabilitation setting (McCloughen et al. 2008). The

handover of frequent service-users requires the same amount of
attention to detail as the handover of new consumers; all
consumer information should be updated regularly, and mental
state and risk level should be reassessed on admission and
thoroughly communicated at handover (McCloughen et al. 2008;
Millar & Sands 2012). The most common care planning
outcomes arising from handover identified in the present study
were decisions to admit the consumer to LDU or HDU, and
decisions to administer PRN medications. It was observed that
immediate care decisions were frequently made during the
initial telephone handover from CATT to the shift leader prior
to the consumer’s arrival. These findings confirm that important
care decisions typically arise from handover, and highlight the
need for accuratelytransferred clinical information. The present
study found that IPU clinicians are required to make rapid
decisions about care based on the information provided to them
in a brief CATT handover, and this reaffirms the need for
effective and accurate communication at handover to facilitate
safe, appropriate care (Fairbanks et al. 2007; Trenoweth 2003).
Transfer of care from community to inpatient settings Transfers
of care from the community to the IPU were observed to involve
several points of contact and types of communication to
facilitate the process. Fairbanks et al.’s (2007) study revealed
the complexity associated with multiple points of

communication in emergency patient transfer, and identified
care transfers as a patient safety issue. Mental health-care
transfers are particularly complex (NSW Health 2012). A key
recommendation of Millar and Sands’s (2012) study was the
development of a structured handover tool that adequately
captures specific risk information for use in acute psychiatric
settings. Further research examining the CATT to IPU transfer
and handover processes is required to determine the specific
information requirements for the purpose of care transfers from
the community to the IPU. The handover environment in this
study was observed to be ‘busy’, and at times chaotic, with staff
coming and going and multiple interruptions. Bost et al. (2012)
reported similar findings in a study examining emergency
department handover, where the chaotic and loud atmosphere
presented several barriers to the paramedics delivering effective
handover to emergency department staff. Participants were
observed to have to repeat the content of handover several times
to different clinicians, resulting in inconsistent information
transferal (Bost et al. 2012). Interestingly, the present study
found that in spite of the busy, noisy handover environment,
there was a high level of consistency in the transfer of clinical
information. An important insight gained from the present study
was the potential impact of staff skill mix on the quality of
handover, and the value of having experienced IPU staff present
during the handover. Senior IPU staff participated actively in

the handover and asked questions relating to the consumers’
care requirements, as compared to junior staff, who were
passive recipients of the handover. Schwartz et al.’s (2011)
study showed that junior nurses typically adopt a passive role to
‘fit in’. A more structured approach to handover that includes
minimum standards for information exchange might facilitate
more active participation in handover by staff at every skill
level. Implications for practice Acute inpatient settings have
been criticized in recent literature for a perceived lack of
consultation with consumers about their care (Fisher & Happell
2009; Frese III et al. 2001; Walsh & Boyle 2009) and lack of
involvement in decision-making (Bowers et al. 2009). As mental
health services move towards a more recovery-oriented
approach (Australian Government 2009; Australian Government
2010), considering and communicating consumer preferences
will become the expected standard in psychiatric settings
(Australian Government 2009). The new Victorian Mental
Health Act (2014) stipulates the importance of involving
consumers in decisions about their care, and respecting
consumer choices and preferences, as the following quote
illustrates: ‘Persons receiving mental health services should be
involved in all decisions about their assessment, treatment and
recovery and should be supported to make, or participate in,
those decisions and their views and preferences should be
respected’ (Victorian Government 2014, p. 2). Consumer

advocates also argue that greater emphasis should be given to
ensuring that the consumer’s preferences are considered
wherever possible to promote collaborative engagement (Fisher
& Happell 2009). Within a largely-restrictive setting, such as an
IPU, the consideration of care preferences via collaborative
engagement with consumers can lead to improved service-user
experience (Walsh & Boyle 2009). This study raises the
question of how best to promote the inclusion of the consumer
preferences in the delivery of handover in acute psychiatric
settings. This study has a number of limitations. First, the
generalizability of the study is limited due to the small sample
size and the fact that it was a single-site study. A limited
number of CATT clinicians participated in the handover, and
therefore, it is difficult to determine with any accuracy how
representative the practices observed in this study are of CATT
handover practice. Second, a single researcher undertook the
observations; the participation of other researchers in the data
collection might have yielded different perspectives on
handover. Nurses dominated the sample of clinicians in the
study, even though CATT and IPU roles are multidisciplinary.
Finally, it is possible that clinician practice was influenced by
the presence of the researcher observing handover, and the
impact this might have had on the study findings is unknown.
The strengths of the study lie in its original contribution to the
foundational body of knowledge on the CATT to IPU handover.

Additionally, the use of a published handover observational tool
for data collection and the prospective observational design
were successful approaches that resulted in the study meeting
its overall aims. CONCLUSION Mental health-care transfers
from the community to inpatient units are particularly complex
and require consistent and accurate communication of
information. Handover serves as the vital link in facilitating
safe continuity of care, yet in spite of its importance to safety
and continuity of care, little is known about the practice of
CATT to IPU handover. Multisite research using large samples
is now needed to extend on these findings and identify the
minimum requirements for safe, accurate CATT to IPU
handover that is inclusive of consumer choices and preferences.
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