The role of dynamic trade-offs in creating safety—A qualitative study of handover across care boundaries in emergency care

•Qualitative study of emergency care handover across boundaries.•Description of tensions in everyday clinical work.•Exploration of the role of dynamic trade-offs.•Application of resilience engineering thinking to handover.

The paper aims to demonstrate how the study of everyday clinical work can contribute novel insights into a common and stubborn patient safety problem—the vulnerabilities of handover across care boundaries in emergency care. Based on a dialectical interpretation of the empirical evidence gathered in five National Health Service organisations, the paper argues that performance variability is an essential component in the delivery of safe care, as practitioners translate tensions they encounter in their everyday work into safe practices through dynamic trade-offs based on their experience and the requirements of the specific situation. The findings may shed new light on the vulnerabilities of the handover process, and they might help explain why improvements to handover have remained largely elusive and what type of future recommendations may be appropriate for improving patient safety.