EM · Clinical handover and ISBAR
Clinical handover and the ISBAR framework in the emergency department
Also known as ISBAR handover · SBAR communication · Clinical handover · Patient handoff · Transfer of care communication · ED-to-ICU handover · Shift change handover · Paramedic-to-ED handover · IMIST-AMBO · I-PASS handoff
Clinical handover and the ISBAR framework in the emergency department — the structured transfer of information and responsibility at every care transition; the five elements of ISBAR (Identify, Situation, Background, Assessment, Recommendation) and how the Identifier distinguishes ISBAR from its parent SBAR; the alternative and extended structures (SBAR, ISOBAR, IMIST-AMBO for paramedic-to-ED, I-PASS for the trainee-to-trainee handoff); the six ED handover types (triage-to-treatment, shift change, ED-to-ward, ED-to-ICU, ED-to-retrieval, ED-to-theatre) and the emphasis, recipient and risk profile of each; the applied steps of a structured handover from preparation through the receiver's readback to the explicit transfer of responsibility; the com…
Practise this topic
On this page
Related topics
- Team-based care and crisis resource management in the emergency department
- Patient disposition and safety-netting in the emergency department
- Breaking bad news and communication in the emergency department — the SPIKES framework
- Medical error and patient safety in the emergency department
- Trauma team leadership
- The primary survey (ABCDE) — the trauma assessment framework
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- The verbal-only handover is the information-loss default — unstructured, undocumented, and unrepeated, it is a leading cause of handover failure and the harm that follows
- A handover that omits the explicit transfer of responsibility leaves two teams each believing the other is in charge — state the transfer aloud and confirm it is received
- The receiver who does not synthesise and read back closes no loop — the readback is the step that catches the omission before the team departs
- The handover given under time pressure, with the receiver multitasking or interrupted, loses the critical detail — protect the handover from interruption
- The junior unable to escalate against a steep authority gradient gives a recommendation-shaped-as-a-question — ISBAR exists to flatten the gradient and force the explicit ask
Meet the patient
The intensive-care consultant answers the phone at 03:00. The ED registrar says: "Doctor, I think we have a problem with a lady down here — she's pretty sick." The consultant waits. There is no identifier, no situation, no vital signs, no clear ask. The line goes silent. The consultant does not know who the patient is, where she is, or why she was called.[1]
The registrar has handed over without a structure. The single most examinable principle in this topic — and the one the I-PASS trial turned into the strongest evidence in patient safety — is that the verbal-only, unstructured handover is the information-loss default, and the structured, read-back handover is the engineered defence.[2]
References8ShowHide
- [1]Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians Jt Comm J Qual Patient Saf, 2006.PMID 16617948
- [2]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program N Engl J Med, 2014.PMID 25372088
- [3]Humphrey KE, Sundberg M, Milliren CE, et al. Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims J Patient Saf, 2022.PMID 35188927
- [4]Harthi N, Almuwallad A, Albargi H, et al. Trauma handover practices between ambulance clinicians, emergency department staff and trauma teams: scoping review BMC Emerg Med, 2026.PMID 41588499
- [5]Gheri F, Presti C, Donnarumma F, et al. Assessing Handover Quality in the Emergency Department: Evaluating Communication Between EMS and Triage Nurses Using the Handoff CEX Italian Scale J Emerg Nurs, 2026.PMID 40833308
- [6]Lazzari C, Rabottini M. The use of Introduction, Situation, Background, Assessment, and Recommendation handover in the COVID-19 pandemic and non-COVID clinical settings: a systematic review and meta-analysis Front Health Serv, 2025.PMID 40851885
- [7]Yari M, Izadi-Avanji FS, Sabery M. Assessment of clinical handover among ICU nurses based on the structured ISBAR model (2025) BMC Nurs, 2026.PMID 41943136
- [8]Rasiya A, Raheem UA. Shift Transition Communication Among Nurses: A Systematic Review of ISBAR and SBAR-Based Structured Handover Tools Nurs Open, 2026.PMID 42338059