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Who to handover: a case–control study of a novel scoring system to prioritise handover of internal medicine inpatients
  1. Jesse Bittman1,
  2. Penny Tam2,
  3. Chris Little1,
  4. Nadia Khan2
  1. 1Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Jesse Bittman, Department of Medicine, 10th Floor, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9; bittmanj{at}


Background Handover of patients between care providers is a critical event in patient care. There is, however, little evidence to guide the handover process, including determining which patients to handover.

Aim Compare the ability of gestalt-based handover with two structured scores, the modified early warning score (MEWS) and our novel iHAND clinical decision support system, to predict which patients will be assessed by a physician overnight.

Methods This case–control study included 90 inpatients, comprising 32 patients assessed overnight (cases) and 58 patients not assessed overnight (controls) at a teaching hospital in British Columbia, Canada (May 2012). Gestalt, MEWS and iHAND scores were analysed against patients seen overnight using logistic regression and receiver-operating characteristic (ROC) curves.

Results Neither current gestalt-based handover practice (odds ratio (OR) 1.50, 95% CI 0.89 to 3.83) nor MEWS (OR 0.96, 95% CI 0.75 to 1.24, area under the ROC curve (AUC) 0.61, 95% CI 0.49 to 0.73) were significantly associated with need to be seen overnight. The iHAND score was associated with need to be seen (OR 1.93, 95% CI 1.24 to 3.02, AUC 0.70, 95% CI 0.60 to 0.81).

Conclusions The iHAND score had moderate ability to predict which patients required assessment overnight, while MEWS score and current gestalt approach correlated poorly, suggesting the iHAND score may help prioritisation of patients likely to be seen overnight for handover.


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