The hand-over process is often described as the clinical hand-over of patient information and transfer of responsibility from one healthcare provider to another. One important hindrance in this hand-over lies in insufficient interprofessional communication where clinical information about the patient's situation may be missed during the process (Bost et al, 2010).
Research regarding the hand-over process is limited and focuses on the handover between the ambulance and the emergency department (ED) (Suserud and Bruce, 2003; Bruce and Suserud, 2005; Fairbanks et al, 2007; Jenkin et al, 2007; Bost et al, 2010). However, the hand-over may begin at the scene of an accident if the fire or police service are the first responder and they hand-over the responsibility for the injured to the ambulance service (Elmqvist et al, 2010). As a matter of fact, the hand-over already starts when the injured is handing over the responsibility for their own body to the first responders (Ahl et al, 2006; Elmqvist et al, 2008).
Not always initiated by the injured, this means that the person who has the information about the situation starts a chain reaction where the responsibility for the injured or ill body in turn is handed over to a chain of persons with more and more specialized competence and resources. This hand-over of responsibility entails a relief for all involved and passes smoothly as long as the information of the situation is further transferred along the chain.
In opposite, lack of information in the hand-over leads to interdependence in a ‘hierarchal domino effect’, which creates a chain of uncertainty and insecurity for all involved in the encounter. There is especially one failing link in the chain of this hand-over, often forgotten and unspoken of, namely the importance to explicitly hand-back the responsibility to the patient (Elmqvist, 2011). The traumatic situations at the scene of an accident create an interruption in the patient's life story and the beginning and the end of the encounter lack demarcations and are protracted. Therefore, the first responders have an important role to fill in the gaps in the patients memories of what happened on the scene so that they could recapitulate the situation and regain control over their body (Elmqvist et al, 2008).
According to the discussion above there are some questions in this hand-over that needs further research and clarification: who is responsible for the interprofessional communication and the transfer of responsibility along the care chain of hand-over? and who is responsible to hand back the responsibility to the patient? Perhaps this should not be on individual basis, but rather at an organizational level.