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. Obser-
ver bias where the results may be influenced by prior expe-
rience 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 collec-
tion was a limitation. The use of video recording of the hand-
over process may have yielded more detailed data, however
pre study conversations between the researchers and ambu-
lance/ED personnel suggested that personnel would be
reluctant to participate if video recorded.