Communication handover barriers among nurses and paramedics in emergency care settings

Abstract

Background

Clear communication during emergency care handovers is crucial for patient safety, but barriers can compromise the process, increasing risks. The aim of this study is to compare and assess communication handover barriers perceived by nurses and paramedics in emergency care settings.

Methods

A cross-sectional survey was conducted using the modified Nursing Handover Perspectives Questionnaire. A convenience sample was used to recruit nurses and paramedics from multiple prehospital and emergency care settings in the Eastern Province of Saudi Arabia. Data were analyzed with SPSS 29, employing descriptive statistics, independent samples t-tests to compare scores between nurses and paramedics. Pearson correlations were utilized to explore relationships between perceptions and demographic variables. Statistical significance was set at P < 0.05.

Results

Out of 250 distributed questionnaires, 219 were completed (87.6% response rate). Most participants were male (75.3%) and held a bachelor’s degree (70.8%). Nurses tended to be older compared to paramedics, who were younger. Nurses reported greater awareness regarding the omission of important vital sign measurements during handover (p = 0.006) and greater opportunities to ask questions about things they did not understand (p = 0.049). Paramedics reported experiencing interruptions during handover at a higher rate than nurses (p = 0.036). Nurses also perceived greater benefit in using a structured handover tool like ISBAR for improving communication (p = 0.014) and patient safety (p = 0.019). No significant correlations were found between demographic variables and perceptions of communication handover barriers.

Conclusions

Nurses reported a higher awareness of omitted vital signs during handover, while paramedics experienced more frequent interruptions. Addressing these barriers through targeted training and the use of supportive technologies may improve communication and patient safety in emergency care. Strengthening collaboration between nurses and paramedics, along with reducing interruptions, could support more effective care transitions. This study adds a comparative perspective on handover barriers in emergency settings and identifies areas for potential intervention. The findings contribute to ongoing discussions on enhancing handover practices and highlight the perceived value of structured frameworks and technology-driven solutions for improving communication efficiency and safety.

Introduction

Communication handover is still one of the most crucial elements of patient safety and organization in any emergency care setting [1]. It describes the handoff of data and accountability during a shift change or patient care transfer from one healthcare professional or team to another [2]. In emergency situations, where quick judgments and actions are crucial, the quality of communication during handovers significantly impacts patient outcomes [3]. Effective handovers ensure that healthcare personnel receive comprehensive information about the patient’s health, therapies, medications, and any recent changes. Inadequate handovers can lead to missing or misinterpreted information, resulting in treatment delays or adverse outcomes [4]. Additionally, weak interprofessional communication processes can hinder shared decision-making and the continuity of care [5].

Unstructured communication and unclear responsibilities during handovers from emergency medical technicians to Emergency Department (ED) staff can endanger patient safety. Establishing clear procedures and promoting accountability can improve handover practices and support integrated, patient-centered care [3]. Standardizing the patient transfer process between pre-hospital emergency medical services and ED professionals is vital to improving communication, reducing data loss, and ensuring safety. This involves delivering detailed patient information, including referral reasons, medical history, drug allergies, and treatments administered, with both verbal and written confirmation [6].

Integrating standardized methods like the ISBAR (Introduction, Situation, Background, Assessment, Recommendation) model has shown significant improvements in handover quality. Studies have demonstrated that using ISBAR in combination with mind map communication modes resulted in lower defect rates, reduced adverse events, and higher nursing satisfaction [7]. Training using structured tools like the ISBAR method has been shown to significantly improve nurses’ knowledge, practice, and perceptions of shift handoff communication in noncritical departments. This highlights the effectiveness of standardized methods in enhancing handover quality and addressing communication challenges [8, 9].

A recent study found significant variations in nurses’ perceptions of bedside handovers across critical care units, highlighting the need for setting-specific improvements in communication and efficiency [10]. A recent multicentre study implemented a ward-level intervention to enhance nursing handover communication, emphasizing bedside interactions, improved documentation, and efficiency. The findings highlight the importance of leadership, collaboration, and systemic changes in achieving sustainable improvements in handover practices [11].

Virtual or online interprofessional learning activities have shown potential in enhancing collaboration and communication among healthcare professionals during patient handovers, even when team members are in different locations [12]. However, challenges persist in paramedic-to-ED handovers, including miscommunication and a lack of structured reception protocols, which can lead to information loss [13].

Interdepartmental conflicts, particularly between emergency physicians and internal medicine physicians, can disrupt patient handoffs and affect collaboration and care quality [14]. Understanding these conflicts can offer insights into the broader challenges of ensuring seamless communication in emergency care settings, including paramedic-to-ED handovers [15]. Addressing these conflicts and enhancing handover processes are essential for improving emergency center operations and patient safety [16]. Standardized communication techniques and adherence to clear protocols are critical for effective handovers [17–19]. Active listening and prioritizing vital information are also key to successful communication [20, 21].

Despite evidence supporting these practices, variability and inconsistency in handover protocols remain a concern [22]. Additionally, there is a significant gap in understanding how non-formal learning programs address these issues. Non-formal learning programs, such as workshops, simulation training, and on-the-job mentorship, aim to enhance healthcare professionals’ handover communication skills outside traditional academic settings. A scoping review has highlighted gaps in existing non-formal patient handover learning programs, including insufficient use of learning theories, limited coverage of multiple settings, and a lack of studies on patient outcomes [23]. Addressing these gaps is crucial for improving the effectiveness of handover training and enhancing patient safety.

Effective communication during handovers is essential for patient safety, yet various barriers persist in emergency care settings [1–3]. This study not only identifies these barriers but also provides evidence-based insights that can guide policy development, training programs, and the integration of structured communication protocols. By highlighting the specific challenges faced by nurses and paramedics, the findings contribute to improving handover efficiency, reducing communication errors, and enhancing patient safety. Thus, this study aims to examine the communication handover barriers perceived by nurses and paramedics in emergency care settings, with a focus on differences in perception and the impact of demographic variables in the eastern province of the Kingdom of Saudi Arabia. By providing insights into these communication challenges, the study seeks to guide the development of targeted interventions and policies to improve patient outcomes and handover effectiveness in emergency care settings.

Research question and hypothesis

Research Question: Is there a significant difference in the perception of communication handover barriers between nurses and paramedics in emergency care settings?

Hypothesis

There is a significant difference in the perception of communication handover barriers between nurses and paramedics in emergency care settings.

Methods

Study design, setting, sample and sampling

A cross-sectional descriptive correlation design was employed to investigate the communication handover barriers as perceived by nurses and paramedics in emergency care settings in the eastern province of the Kingdom of Saudi Arabia. Given the differences in roles and responsibilities between these two groups, the study aimed to compare their perceptions and identify unique challenges in handover communication.

The study was conducted in emergency care settings, including prehospital emergency medical services and hospital-based emergency departments. The handover process in these settings involves paramedics transferring patient care responsibility to ED nurses, typically through verbal and written reports. Paramedics provide critical prehospital information, such as patient condition, interventions performed, and ongoing concerns, while ED nurses assume responsibility for triaging, stabilizing, and continuing patient management [3, 6]. However, variations in handover structure, communication styles, and time constraints can impact the effectiveness of information transfer [2, 7]. By examining these interactions, this study aims to identify key barriers affecting handover quality and patient safety.

A convenience sample of emergency care personnel, including nurses and paramedics, from multiple prehospital and emergency care settings were surveyed. Other healthcare providers, such as physicians, administrators, pharmacists, and other professionals working in emergency care settings, were excluded. The study was conducted from March 2024 to September 2024.

Following Cohen’s (1992) guidelines, the sample size was determined. A total of one hundred participants per group is required, based on a power of 0.80, an alpha (α) level of 0.05, and a medium effect size of 0.25. To account for potential dropout, oversampling was implemented [24]. In practice, the final sample size remained within the expected range, ensuring sufficient representation of the target population. This approach minimized the risk of attrition bias and improved the reliability of the findings.

Tool

This research used an anonymous online self-report survey, customized for the study. The survey was structured into two parts. The first part collected demographic data, including participants’ age, gender, education, job title, and work experience. The second part comprised the Nursing Handover Perspectives Questionnaire (NHPQ). This self-administered questionnaire was originally adapted from (Klim et al., 2013) and (Street et al., 2011) [25, 26]. A validated 22-item (NHPQ) questionnaire was adopted by (Pun et al., 2019) and used in this study [27]. While the tool was originally nursing-focused, it was deemed appropriate for this study as paramedics also engage in critical handover communication with emergency department personnel. To ensure applicability, we reviewed the questionnaire’s content and confirmed that its key domains—such as information transfer, interruptions, and structured handovers—were relevant to both nurses and paramedics. This adaptation aligns with prior studies that have applied similar nursing-based handover tools to interprofessional handover contexts. The survey includes 22 items using a 4-point Likert scale, with responses ranging from ‘Strongly disagree’ (1) to ‘Strongly agree’ (4), and higher scores reflect a greater degree of agreement. The levels of agreement were classified as follows: 1 to 1.74 (low), 1.75 to 2.49 (moderate low), 2.50 to 3.24 (moderate high), and 3.25 to 4 (high) [28]. The dimensions of the questionnaire identified communication skills and the quality of handover. The tool demonstrated a high level of reliability, with a Cronbach’s alpha of 0.99 and a 95% confidence interval greater than 0.7 [19]. In this study, the psychometric characteristics of the tool and the time needed to finish the survey were assessed in a pilot study. The overall reliability, measured by Cronbach’s alpha, was 0.84.

Ethical considerations and data gathering

This research obtained approval from the Institutional Review Board (IRB) at Imam Abdulrahman Bin Faisal University (IRB-2024-03-199) and followed the ethical principles described in the Declaration of Helsinki. Potential participants were informed of the study’s risks and benefits before enrollment, with the study’s purpose clearly explained. Participation was emphasized as voluntary, with assurances of anonymity and confidentiality, as well as the right to withdraw at any time without any impact on their existing or future employment. Upon agreeing to participate, individuals were asked to complete the necessary surveys. The researcher obtained approval from the relevant directors or managers to conduct the study following IRB approval. Participants received an electronic questionnaire accompanied by a cover letter, and their consent was implied through the completion and return of the questionnaire.

Data analysis

The data were processed and analyzed with version 29 of the Statistical Package for the Social Sciences (SPSS) for Windows [29]. The data were screened for outliers and evaluated for normality using a modified Z-score, confirming a normal distribution. Descriptive statistics summarized demographic data and the perception of communication handover barriers. An Independent Samples t-Test were employed to compare the mean perception scores between nurses and paramedics. Additionally, Pearson correlation coefficients were calculated to examine relationships between the perception of communication handover barriers and demographic variables. Statistical significance being set at P < 0.05.

Results

Of the 250 surveys distributed, 219 were completed (87.6% response rate), with 47.5% nurses and 52.5% paramedics. Most participants were male (75.3%) and held a bachelor’s degree (70.8%). Paramedics were younger, with 45.2% aged 24–30, while 56.7% of nurses were over 30. Paramedics had less clinical experience, with 61.7% having under 5 years, compared to 41.3% of nurses with over 10 years. Overall, 60.7% of participants had received communication training, as indicated in Table 1.

Table 1.

Demographic characteristics of participants. (N = 219)

	Nurse		Paramedic		Total
	N	%	N	%	N	%
Job title	104	47.5	115	52.5	219	100
Age
< 24 years old	14	13.5	30	26.1	44	20.1
24–30 years old	31	29.8	52	45.2	83	37.9
> 30 years old	59	56.7	33	28.7	92	42.0
Gender
Male	61	58.7	104	90.4	165	75.3
Female	43	41.3	11	9.6	54	24.7
Education
Less than diploma	1	1	4	3.5	5	2.3
Diploma degree	11	10.6	15	13.0	26	11.9
Bachelor’s degree	70	67.3	85	73.9	155	70.8
Post-graduate degree	22	21.2	11	9.6	33	15.1
Years of clinical experience
< 5 years	43	41.3	71	61.7	114	52.1
5–10 years	18	17.3	20	17.4	38	17.4
> 10 years	43	41.3	24	20.9	67	30.6
Communication training
No	37	35.6	49	42.6	86	39.3
Yes	67	64.4	66	57.4	133	60.7

An Independent Samples t-Test was used to compare the mean perception scores between nurses and paramedics across various communication handover barriers. Both groups moderately agreed that they received adequate information during handovers, with nurses scoring 2.65 ± 0.514 and paramedics 2.59 ± 0.495 (p = 0.334). However, nurses reported a higher awareness of vital signs being omitted during handovers (2.33 ± 1.092) compared to paramedics (1.93 ± 1.015, p = 0.006), as indicated in Table 2.

Table 2.

Comparison of the mean perception scores of communication handover barriers between nurses and paramedics

		Nurse (n = 104)		Paramedic (n = 115)		All (n = 219)		t statistics	df	P-Value
#	Statement	Mean ± SD	Rank	Mean ± SD	Rank	Mean ± SD	Rank
Adequate information
1.	I have been provided with adequate information about patients in my care.	3.11 ± 0.835	MH	3.00 ± 0.838	MH	3.05 ± 0.836	MH	0.934	217	0.351
2.	I feel that important information was not given to me.	2.24 ± 0.990	ML	2.38 ± 0.894	ML	2.32 ± 0.942	ML	1.117	217	0.265
3.	The information I received during handover is often not relevant to my patient care.	2.13 ± 1.086	ML	2.17 ± 0.982	ML	2.15 ± 1.03	ML	0.288	217	0.774
4.	The information I received was up to date.	3.15 ± 0.890	MH	3.05 ± 0.867	MH	3.10 ± 0.877	MH	0.856	217	0.393
5.	I received adequate information about nursing/EMS care during handover.	3.08 ± 0.784	MH	3.08 ± 0.829	MH	3.08 ± 0.806	MH	0.012	217	0.990
6.	From my observations, important vital sign measurements are often omitted from nursing/EMS handover, for example BP < 100, oxygen saturation < 93%.	2.33 ± 1.092	ML	1.93 ± 1.015	ML	2.12 ± 1.069	ML	2.784	217	0.006*
7.	From my observations, important information about medication is often not given during handover, for example withheld, allergy, unavailable.	2.54 ± 1.105	MH	2.50 ± 1.012	MH	2.52 ± 1.055	MH	0.299	217	0.765
	Overall, adequate information subscale	2.65 ± 0.514	MH	2.59 ± 0.495	MH	2.62 ± 0.504	MH	0.969	217	0.334
Organizing information
8.	The handover information was presented in a systematic and organized way.	2.95 ± 0.852	MH	2.81 ± 0.887	MH	2.88 ± 0.872	MH	1.215	217	0.226
9.	The chart/Patient Care Report were available during handover to clarify information provided to me.	2.98 ± 0.945	MH	2.83 ± 0.936	MH	2.90 ± 0.941	MH	1.147	217	0.252
10.	I have used the chart/Patient Care Report to review patient care during handover, for example drug, vital signs, patient allergy.	3.16 ± 1.025	MH	2.93 ± 0.980	MH	3.04 ± 1.006	MH	1.719	217	0.087
11.	The way in which information was provided to me was easy to follow.	3.04 ± 0.858	MH	3.00 ± 0.848	MH	3.02 ± 0.851	MH	0.333	217	0.739
	Overall, organizing information subscale	3.03 ± 0.786	MH	2.89 ± 0.754	MH	2.96 ± 0.771	MH	1.344	212.660	0.180
Comprehension of receiving handovers
12.	I was unable to keep my mind focused during handover due to excessive noise.	2.61 ± 1.056	MH	2.37 ± 0.995	ML	2.48 ± 1.029	ML	1.672	217	0.096
13.	As a result of handover, I have a clear understanding of the patient care plan.	3.11 ± 0.902	MH	2.99 ± 0.822	MH	3.05 ± 0.861	MH	0.983	217	0.327
	Overall, comprehension of receiving handovers subscale	2.86 ± 0.759	MH	2.68 ± 0.657	MH	2.76 ± 0.711	MH	1.810	217	0.072
Communicating skills
14.	I think effective communication skills should be used for handover, for example clear speech, not too fast.	3.50 ± 0.892	H	3.50 ± 0.831	H	3.50 ± 0.859	H	0.037	217	0.970
15.	From my experience, handover was often interrupted by patients, their significant others, or other staff.	2.74 ± 1.005	MH	3.03 ± 0.995	MH	2.89 ± 1.008	MH	2.112	217	0.036
	Overall, communicating skills subscale	3.12 ± 0.784	MH	3.27 ± 0.770	MH	3.20 ± 0.778	MH	1.380	217	0.169
Seeking further information
16.	I had to seek further information about my patient(s) from other healthcare providers after the handover.	2.85 ± 0.953	MH	3.03 ± 0.903	MH	2.94 ± 0.929	MH	1.434	217	0.153
Asking questions and resolving concerns
17.	I had the opportunity to ask questions about things I did not understand during handover.	3.05 ± 0.928	MH	2.86 ± 0.954	MH	2.95 ± 0.944	MH	1.469	217	0.143
18.	I was asked to clarify if I have any questions about the information received.	2.99 ± 0.980	MH	2.72 ± 0.969	MH	2.85 ± 0.982	MH	2.037	217	0.043*
	Overall, asking questions and resolving concerns subscale	3.02 ± 0.862	MH	2.79 ± 0.835	MH	2.90 ± 0.853	MH	1.984	213.270	0.049*
Creating a clear patient plan
19.	I believe using a structured, standardized framework for handover, such as ISBAR (Introduction, Situation, Background, Assessment, Recommendation) will help me to improve communication skills with my co-workers.	3.53 ± 0.812	H	3.24 ± 0.884	MH	3.38 ± 0.861	H	2.479	217	0.014*
20.	I believe using a structured, standardized framework for handover, such as ISBAR (Introduction, Situation, Background, Assessment, Recommendation) will increase patient quality and safety care.	3.63 ± 0.738	H	3.37 ± 0.873	H	3.50 ± 0.820	H	2.373	217	0.019*
21.	I think a structured, standardized framework for handover, such as ISBAR (Introduction, Situation, Background, Assessment, Recommendation) is time consuming.	2.49 ± 1.199	ML	2.47 ± 1.103	ML	2.48 ± 1.147	ML	0.134	217	0.894
	Overall, creating a clear patient plan subscale	3.22 ± 0.674	MH	3.03 ± 0.746	MH	3.12 ± 0.718	MH	1.959	217	0.051
Recommendation
22.	I think a structured, standardized framework for handover, such as ISBAR (Introduction, Situation, Background, Assessment, Recommendation) is not easy to implement in my handovers.	2.43 ± 1.086	ML	2.52 ± 0.967	MH	2.48 ± 1.024	ML	0.642	217	0.522
Overall mean perception scores.		2.89 ± 0.497	MH	2.81 ± 0.455	MH	2.85 ± 0.477	MH	1.295	217	0.197

*Significant at p < 0.05. For Rank section: L mean Low level of agreement, ML mean Moderate Low level of agreement, and MH mean Moderate High level of agreement, H mean High level of agreement. “‘the bold values provided in this table are the overall mean and SD (standard deviation) for each communication handover barriers subscale.”

Regarding the organization of information, there was no significant difference, with nurses scoring 3.03 ± 0.786 and paramedics 2.89 ± 0.754 (p = 0.180). Although nurses had slightly higher scores for comprehension of handovers (2.86 ± 0.759) than paramedics (2.68 ± 0.657), this difference was not statistically significant (p = 0.072).

A significant difference was identified in the perception of interruptions during handover, with paramedics reporting more frequent interruptions (3.03 ± 0.995) compared to nurses (2.74 ± 1.005, p = 0.036). While overall communication skills were similar (nurses 3.12 ± 0.784, paramedics 3.27 ± 0.770, p = 0.169), nurses felt they had more opportunities to ask questions during handover (3.02 ± 0.862 for nurses, 2.79 ± 0.835 for paramedics, p = 0.049).

Nurses also reported a higher rate of agreement that using a structured handover framework like ISBAR improves communication (3.53 ± 0.812 for nurses, 3.24 ± 0.884 for paramedics, p = 0.014) and patient safety (3.63 ± 0.738 for nurses, 3.37 ± 0.873 for paramedics, p = 0.019).

These findings highlight statistically significant differences in certain areas of information exchange, particularly regarding omitted vital signs, interruptions during handover, perceived value of structured handover frameworks, and the opportunity to ask questions.

The results in Table 3 demonstrated that there were no statistically significant correlations between the perception of communication handover barriers and the demographic variables examined. Age had a very weak positive correlation (r = 0.046, p = 0.501), while gender showed a very weak negative correlation (r = -0.039, p = 0.563). Similarly, the level of education (r = -0.070, p = 0.304) and job title (r = -0.088, p = 0.197) demonstrated weak negative correlations. Years of clinical experience (r = 0.062, p = 0.362) and communication training (r = 0.090, p = 0.183) both demonstrated weak positive correlations. Overall, none of the demographic variables were significantly correlated with the perception of communication handover barriers (p > 0.05).

Table 3.

The correlation between the perception of communication handover barriers and demographic variables

Demographic data	Mean ± SD	r	P value
Age	2.22 ± 0.759	0.046	0.501
Gender	1.25 ± 0.432	-0.039	0.563
Level of education	2.99 ± 0.602	-0.070	0.304
Job title	1.53 ± 0.501	-0.088	0.197
Years of clinical experience	1.79 ± 0.885	0.062	0.362
Communication training	1.61 ± 0.489	0.090	0.183

* Correlation is significant at the 0.05 level

In summary, this study addressed the research question: “Is there a significant difference in the perception of communication handover barriers between nurses and paramedics in emergency care settings?” Although several differences in mean scores were observed, only a few were statistically significant. Specifically, nurses reported greater awareness of omitted vital signs and more opportunities to ask questions during handover, while paramedics more frequently experienced interruptions. Both groups moderately agreed that they received adequate information, and no significant differences were found in areas such as information organization and overall communication skills. Perceptions regarding the use of structured frameworks like ISBAR also differed significantly, with nurses showing stronger support. Importantly, demographic variables such as age, gender, education level, and experience were not significantly correlated with perceptions of communication handover barriers.

This study contributes to the understanding of communication handover barriers by reinforcing prior findings on the role of interruptions while adding insights into paramedics’ perspectives on this issue. While previous research has highlighted interruptions as a known challenge, the findings provide additional data specific to paramedics’ experiences. Furthermore, the study emphasizes the perceived benefits of structured frameworks like ISBAR, rather than establishing their direct impact.

Future research should focus on interventions for communication barriers, the long-term impact of structured frameworks, and variations across settings. The study addressed the research question by highlighting key differences in handover perceptions between nurses and paramedics, especially regarding interruptions and information omission.

Discussion

This study provides critical insights into communication barriers during patient handover between paramedics and nurses, highlighting key areas for improvement to enhance patient safety. Nurses play a central role in the handover process, often acting as the primary receivers of prehospital information. While both paramedics and nurses expressed moderate agreement on the adequacy of information transfer, significant differences emerged in their perceptions.

Nurses were more likely to perceive omitted crucial patient information, particularly vital signs, compared to paramedics, who reported frequent interruptions during handovers. These findings may reflect those nurses perceive structured handover protocols as more effective in ensuring comprehensive patient information transfer, while paramedics may experience more environmental distractions during handovers. These findings align with previous studies that highlight the importance of comprehensive information transfer during handovers [1, 21, 30, 31]. Interruptions in emergency settings have also been identified as significant risks to effective communication [3, 32]. Previous studies reinforce that structured handover, such as the ISBAR model, improve communication and patient safety [7, 33, 34].

Nurses in this study strongly supported ISBAR, indicating its value in maintaining clarity and completeness in emergency care transitions. Nurses’ heightened awareness of vital sign omissions may be attributed to their clinical training, which emphasizes comprehensive patient assessments and continuous monitoring. This perceived understanding of handovers may be influenced by their more frequent exposure to structured protocols like ISBAR, which are designed to support comprehensive information exchange [1, 6, 8]. Additionally, nurses may have more opportunities to ask questions during transfers due to their role in ongoing care and their involvement in clarifying patient conditions for continuity of care [5, 6].

Despite these communication challenges, no significant correlations were found between demographic factors and perceptions of handover quality. This suggests that systemic factors such as workflow pressures and the lack of standardized protocols may be greater barriers than individual characteristics. These findings align with prior research indicating that emergency handover quality is often determined by institutional practices rather than provider specific attributes [6, 35, 36]. The lack of such correlations in this study may point to systemic barriers within the emergency care process itself, rather than differences based on individual factors [14, 37].

Moreover, paramedics reported more frequent interruptions during handovers compared to nurses. This is consistent with literature suggesting that the chaotic nature of pre-hospital environments often leads to increased distractions, which negatively affect communication quality [21, 38]. Interruption-prone settings require enhanced strategies to mitigate their impacts, such as stricter adherence to structured handover protocols, which paramedics reported using less frequently than nurses [16].

A critical concern identified was the lack of formalized handover training, particularly among paramedics. This is a critical oversight, as numerous studies indicate that structured handover education improves communication effectiveness and patient safety [23, 30, 39]. While nurses typically receive structured communication training as part of their clinical education, paramedics may have less exposure to standardized handover frameworks. This aligns with prior literature suggesting that pre-hospital professionals experience greater variability in handover protocols, leading to inconsistencies in information transfer [3, 8]. Healthcare organizations should prioritize implementing formal training programs that promote standardized communication models, such as ISBAR, across all levels of care providers, including paramedics and emergency department staff [8, 40–43]. Given the essential role of nurses in ensuring effective patient handovers, enhancing nurse-led handover education and cross-disciplinary training programs can bridge this gap.

The study’s findings offer actionable insights that can drive improvements in emergency handover protocols, training strategies, and technological advancements. Given the significant role of structured frameworks like ISBAR in improving communication, policymakers and healthcare institutions should prioritize their implementation in emergency settings. Furthermore, addressing frequent interruptions, particularly among paramedics, by establishing dedicated handover zones and leveraging electronic documentation tools can enhance information accuracy and continuity of care. These practical recommendations underscore the immediate applicability of this study in optimizing real-world handover practices and patient safety initiatives.

Limitations and future research

This study’s limitations include its geographic scope, focusing on a specific region in Saudi Arabia, which may not be generalizable to other healthcare settings with different organizational structures and cultural contexts. Additionally, the study’s cross-sectional design prevents any causal inferences, limiting the ability to definitively link specific communication barriers to adverse patient outcomes. The absence of qualitative data also limited the ability to explore the deeper, contextual nuances of handover challenges from the perspectives of nurses and paramedics.

A key limitation of this study is the use of a nursing-focused tool (NHPQ) may not fully reflect paramedic-specific handover experiences. While the tool was adapted and found relevant for paramedics, it may not fully capture paramedic-specific handover challenges. Future research should consider developing or validating handover assessment tools specifically designed for paramedics to better reflect their unique handover dynamics and challenges.

Although oversampling was implemented to account for potential dropout, participant retention remained high, and the final sample size was sufficient for analysis. While this ensured statistical robustness, the use of a convenience sampling method may still limit the generalizability of the findings. Future research could consider probabilistic sampling methods to enhance representativeness across different emergency care settings.

Future research could employ mixed methods, integrating surveys and qualitative interviews to gain deeper insight into handover experiences and barriers. Investigating the effectiveness of communication training, particularly ISBAR adoption among paramedics, would be valuable. Additionally, exploring the impact of electronic handover tools on improving information transfer, especially in emergency settings, is important [22, 44]. Lastly, expanding the scope of research to include multiple regions and healthcare systems would help in developing globally applicable strategies for improving handover practices across diverse settings [15].

Moreover, the findings underscore the potential value of technology in addressing communication barriers. Nurses and paramedics alike would benefit from electronic documentation tools that streamline information transfer and reduce reliance on memory-based handovers [20, 44]. Future research should examine the effectiveness of these tools in real-time emergency settings to optimize handover reliability and improve patient outcomes.

Conclusions

This study highlights critical communication barriers during handovers between nurses and paramedics in emergency care. Nurses reported greater awareness regarding the omission of important vital sign measurements during handover, while paramedics faced frequent interruptions, impacting the efficiency and accuracy of patient information transfer. Addressing these challenges may benefit from targeted interventions, particularly nurse-led training programs that emphasize structured handover frameworks like ISBAR. Simulation-based interdisciplinary training may help improve real-time communication skills, ensuring both nurses and paramedics are well-prepared for seamless care transitions.

Minimizing interruptions and promoting structured handover protocols may improve handover efficiency. Establishing dedicated handover zones in emergency departments could help reduce distractions, while standardized checklists may enhance the consistent transfer of critical patient information. Additionally, integrating digital handover tools has the potential to enhance real-time documentation and accuracy, streamlining communication between prehospital and hospital care teams. Nursing informatics strategies could be leveraged to support these technological advancements, ensuring a more structured and reliable handover process.

Beyond its theoretical contributions, this study offers practical insights for improving emergency handover processes. Future research should focus on evaluating the long-term impact of nursing-led handover training programs on patient safety and care quality. Additionally, investigating the effectiveness of digital solutions in reducing communication errors during emergency care transitions is crucial. Adopting these evidence-informed strategies may support nurses in enhancing handover practices, potentially improving patient outcomes and strengthening interdisciplinary collaboration in emergency care settings.

Abbreviations

ED

Emergency Department

ISBAR

(Introduction, Situation, Background, Assessment, Recommendation)

ICU

Intensive Care Unit

NHPQ

Nursing Handover Perspectives Questionnaire

IRB

Institutional Review Board

SPSS

Statistical Package for the Social Sciences

Author contributions

S.A. and T.A. wrote the main manuscript text. All authors reviewed the manuscript.

Funding

The author declare that they did not receive any financial support for this study.

Data availability

The data available in Harvard Dataverse: https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi%3A10.7910%2FDVN%2FOUHGMS&version=DRAFT.

Declarations

Ethics approval and consent to participate

This study was approved by the Institutional Review Board (IRB) of Imam Abdulrahman Bin Faisal University (IRB-2024-03-199). After obtaining IRB approval, the researcher secured permission from the relevant directors or managers to conduct the study. Participants were provided with an electronic questionnaire accompanied by a cover letter, and their consent was implied through the completion and return of the questionnaire.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.