Validation of a handoff assessment tool: The Handoff CEX

Leora I. Horwitz*, Janet Dombroski, Terrence E. Murphy, Jeanne M. Farnan, Julie K. Johnson, Vineet M. Arora

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Aims and objectives. Test the feasibility and validity of a handoff evaluation tool for nurses. Background. No validated tools exist to assess the quality of handoff communication during change of shift. Design. Prospective cohort study. Methods. A standardised tool, the Handoff CEX, was developed based on the mini-CEX. The tool consisted of seven domains scored on a 1-9 scale. Nurse educators observed shift-to-shift handoff reports among nurses and evaluated both the provider and recipient of the report. Nurses participating in the report simultaneously evaluated each other as part of their handoff. Results. Ninety-eight evaluations were obtained from 25 reports. Scores ranged from 3-9 in all domains except communication and setting (4-9). Experienced (>five years) nurses received significantly higher mean scores than inexperienced (≤five years) nurses in all domains except setting and professionalism. Mean overall score for experienced nurses was 7·9 vs 6·9 for inexperienced nurses. External observers gave significantly lower scores than peer evaluators in all domains except setting. Mean overall score by external observers was 7·1 vs. 8·1 by peer evaluators. Participants were very satisfied with the evaluation (mean score 8·1). Conclusions. A brief, structured handoff evaluation tool was designed that was well-received by participants, was felt to be easy to use without training, provided data about a wide range of communication competencies and discriminated well between experienced and inexperienced clinicians. Relevance to clinical practice. This tool may be useful for educators, supervisors and practicing nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.

Original languageEnglish (US)
Pages (from-to)1477-1486
Number of pages10
JournalJournal of Clinical Nursing
Issue number9-10
StatePublished - May 2013


  • Communication
  • Evaluation
  • Handover
  • Nurses
  • Nursing
  • Nursing education
  • Transfer of care

ASJC Scopus subject areas

  • General Nursing


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