Emergency Department to Inpatient Care Transition: A Narrative Review of Handover Failures, Diagnostic Momentum, and Patient Safety

The transition of care from the emergency department (ED) to inpatient services is a high-risk clinical boundary in acute medical admissions. During this process, the patient, clinical information, diagnostic reasoning, therapeutic responsibility, pending investigations, and escalation plans must move together. When this transfer is incomplete, patients may be vulnerable to missed results, medication discrepancies, unclear ownership, delayed escalation, and diagnostic momentum, where a provisional ED label becomes accepted by subsequent teams without adequate reassessment. This narrative review examines handover failures, diagnostic momentum, and patient-safety risks during ED-to-inpatient care transitions. It also discusses how these transitions differ across health-system structures, including hospitalist-based models, acute medical take pathways, consultant-unit systems, ward transfers, high-dependency units (HDU), and intensive care settings. Common vulnerabilities include incomplete communication of illness severity, working diagnosis, diagnostic uncertainty, treatment response, pending tests, medication risks, and contingency plans. Structured communication tools such as SBAR (Situation, Background, Assessment, Recommendation) and I-PASS (Illness Severity, Patient Summary, Action List, Situation Awareness and Contingency Planning, Synthesis by Receiver) may improve reliability when adapted to local workflows, supported by training, and paired with receiver confirmation. The review proposes practical handover elements for acute medical admissions, emphasizing illness severity, key differentials, pending tasks, medication reconciliation, escalation triggers, and explicit accountability for follow-up. The ED-to-inpatient transition should be treated as an active patient-safety intervention rather than a purely administrative movement of the patient. Clear communication of uncertainty, trajectory, and responsibility may reduce preventable harm during acute medical admissions.