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Improving handovers: the inverted pyramid model
  1. Sajini Wijetilleka,
  2. Tudor P Toma
  1. Department of Respiratory Medicine, University Hospital Lewisham, Lewisham, London, UK
  1. Correspondence to Dr Tudor P Toma, University Hospital Lewisham, Lewisham High Street, Lewisham, London SE13 6LH, UK; ttoma{at}

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Safe, efficient handovers are essential in the contemporary health service. During a 24 h inpatient stay, the care of a patient is transferred at least twice, between day and night teams. In shift based emergency departments, intensive and high dependency units, the number of handovers is increased. Deficient handovers may have serious consequences, such as delays in diagnosis, increases in the likelihood of adverse events, and greater health care costs.1

Dynamic medical systems require simple and efficient ways to organise medical information that is verbally transmitted during a handover. Current models used at medical handovers use the storytelling tradition as a background. Information is presented in heavily summarised impressions of reviewed patients with a beginning, middle, and end. Consequently, some of the less important details and administrative information are relayed first. Summarised histories follow, with important management and prognostic details coming last.

Transferring important information first

Exchanging the most important information usually towards the end of the handover occurs by convention and may be detrimental to the efficacy of handovers. We propose that this convention should be actively changed so all handover inpatient summaries should be made using the inverted pyramid structure. This means that crucial clinical details about the patient are to be transferred first. Choosing a presentation model centred on the most important information first might be a simple change that may improve communication …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.