Critical Care

, 16:303

First online:

A handoff is not a telegram: an understanding of the patient is co-constructed

  • Michael D CohenAffiliated withSchool of Information, University of Michigan Email author 
  • , Brian HilligossAffiliated withDivision of Health Services Management and Policy, College of Public Health, Ohio State University
  • , André Carlos Kajdacsy-Balla AmaralAffiliated withDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto Email author 


Hospital handoffs are believed to be a key locus of communication breakdown that can endanger patient safety and undermine quality of care. Substantial new efforts to better understand handoffs and to improve handoff practices are under way. Many such efforts appear to be seriously hampered, however, by an underlying presumption that the essential function of a handoff is one-way information transmission. Here, we examine social science literature that supports a richer framing of handoff conversations, one that characterizes them as co-constructions of an understanding of the patient.