Do you still use paper handover lists? Answers on a postcard please


by Dr DJ Hamblin-Brown Senior physical leader and Emergency Doctor, Digital Health Entrepreneur

The other day, I saw this twitter conversation.

“Ward nurses and student nurses – do you still use paper handover sheets? Or are you expected to stick to electronic records?”

reproduced below, with names redacted:

The answer that comes back is “Yes” – with a clear implication that paper is better.

And yet within these reply, there is an admission that the hugely valuable information contained in these paper handover sheets is wasted – “shredded at the end of the day”.

Presumably, the next nurse on-shift then writes their own list, with all the time wasted and transcription errors that might involve.

The question is: why is this still happening in an age when so much of our communication has become electronic?

It may be worth asking these presumably millennial nurses: “Do you still write hand-written memos to your colleagues, or are you expected to use email?” and see how many say:

“Oh, I always write to my colleagues using postcards – and when I receive one myself, I read it and then shred it”.

This is presumably unlikely, because email is hugely more convenient, time saving and efficient (not, of course, that it doesn’t have some disadvantages because of that).

The reason, therefore is that there is no application in common use which adequately does what paper does. There is no Hotmail equivalent for handover.

My view is that healthcare IT systems at the organisational level take a very long time to catch-up with the new user needs. Most HIS and EPR systems have been derived from billing and order-management automation – the first, highly-transactional parts of healthcare to be addressed.

The huge gaping hole that exists in our healthcare organisations around electronic handover – which is done so easily on paper – is also a function of the fact that this sort of communication needs flexibility of data-input. Often we need free-text rather than huge number of input fields, with tick boxes that satisfy management super-structures.

The needs of nurses and doctors like those above are the principle reason we created the CAREFUL platform (, which provides:

  • a persistent clinical summary that everyone can see and share
  • a list of tasks that can be both shared and allocated
  • person-to-person handover of responsibilities and tasks
  • team-to-team referral and collaboration
  • patent-status and location tracking

Although we say so ourselves, we think it is also done elegantly and using as much ‘free text’ as is feasible.

Let’s hope in a few years, when the same question is asked, that there is no need for people to share “the best way to handover on paper”