Answer to "How do we assess handover performance?"


It is important to have available tools that can be used to assess the competency of handover participators. Validated tools can be used by educators and clinical providers to ensure students and clinical workers are competent in this important skill, and to also assess the impact and sustainability of interventions to improve the handover process.


An externally validated educational evaluation tool, the handover CEX, is used widely to assess the performance of the handover provider and recipient. This handover CEX assesses six domains on a 9-point scale: setting, organisation, communication, content, judgement and professionalism. There is a range of other assessment tools used to assess attitudes, confidence, knowledge and skills relating to handover, often in the context of evaluating the impact of educational interventions. While a few of these are externally validated, most are designed in response to specific local education programmes without dissemination and external validation.


Despite this lack of published evidence, many such tools are incorporated into standard assessments, such as OSCEs and as such use the variety of global and point rating scales employed within these assessments. Additionally, within the UK, several postgraduate colleges have work based assessments which are requirements across all trainees and use similar items as on the handover CEX. There are currently no other disseminated tools or methods in widespread use.


Further reading

Gaffney, S., Farnan, J. M., Hirsch, K., McGinty, M., et al. (2016) ‘The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance’, Journal of General Internal Medicine, 31(4), pp. 438–441.

Gordon, M., Hill, E., Stojan, J. N. and Daniel, M. (2018) ‘Educational Interventions to Improve Handover in Health Care: An Updated Systematic Review’, Academic Medicine, 93(8), pp. 1234–1244.

Horwitz, L. I., Dombroski, J., Murphy, T. E., Farnan, J. M., et al. (2013) ‘Validation of a handoff assessment tool: the Handoff CEX’, Journal of Clinical Nursing, 22(9–10), pp. 1477–1486.