Limitations
There were several limitations to this study. We used an observational method and interviews to collect data at only one site. Consequently the findings may not be generalisable to other EDs. Overt observation during data collection may have subtly changed participants’ behaviour during clinical handover (i.e. Hawthorne effect) although the researcher took active measures to be integrated into the field. Observer bias where the results may be influenced by prior experience of the situation being observed was limited initially due to the observer’s unfamiliarity with the ED environment.However observer bias may have been present in the later stages of the study as the researcher became more familiar with the setting and participants. Relying on memory and
written documentation during the observational data collection was a limitation. The use of video recording of the handover process may have yielded more detailed data, however pre study conversations between the researchers and ambulance/ED personnel suggested that personnel would be reluctant to participate if video recorded.