## 4 Discussion  
Most handover evaluation tools available in the literature assess transfers that occur in non-emergency settings, where the patient is not in a critical condition [25; 26; 27; 28; 30]. On the other hand, most of the instruments identified that do evaluate handover in urgent care and emergency settings do not validate their application in that field and are, therefore, not considered validated assessment tools [21; 33; 34]. The methodological quality of the psychometric properties of the tools included in this review was determined using the COSMIN checklist [23]. While the tools presented by [PERSON] et al. [24] and [PERSON] et al. [31] comply with 7 of the 10 COSMIN items [23], [PERSON] et al. [29] only complywith 3. It should be noted that COSMIN [23] is a very strict tool in which the final score obtained in each of the sections is determined by the lowest value of the items evaluated. Therefore, non-compliance with even a single factor already ranks the tool in a lower category [23]. For this reason, the ranking of the methodological quality of the articles which validate the handover assessment tools analyzed in this review is doubtful. The instrument by [PERSON] et al. [29], the Emergency Medicine Handoff Tool, is divided into four domains: \"non-clinical patient information\", \"clinical patient information\", \"evolution of the patient in the emergency department\", and \"general condition of the patient in the emergency department\". By contrast, [PERSON] et al. [24] divided their tool into three domains: \"shared mental model index (SMMi)\",\"perception\", and \"transfer and team\". [PERSON] [31] divided his instrument into three domains: \"intrinsic load\", \"extraneous load\", and \"germane load\". As a whole, these authors have taken into account a wide variety of items to assess handovers in emergency medicine. Regarding the items and factors that make up the tools, there was some discrepancy with the recommendations of the WHO and JCAHO to improve communication between professionals in the WHO Patient Safety Solutions [15; 16]. Both [PERSON] et al. [29] and [PERSON] et al. [24] assessed only patient identification, while experts point to the correct identification of professionals as essential to guaranteeing proper transmission of information [5; 15; 16; 18]. Nevertheless, there were also items in the aforementioned studies that the WHO and JCAHO [15; 16] consider important elements for the transfer of information. Experts confirm that the optimal location for the transfer is the bedside [8]. [PERSON] [29] mentions the location where the information was transferred through the item \"localization\" within the \"non-clinical patient information\" domain. Another relevant aspect for experts is the field in which the information is transferred. [PERSON] [35] describes a \"good handover\" as quiet, respectful, and organized, whereas [PERSON] [18] explains that a \"difficult handover\" is chaotic and noisy, with multiple interruptions and with no clear leadership. Both [PERSON] [24] and [PERSON] [31] considered the environment in which information was transferred. [PERSON] [24] evaluates it through the item \"degree of interruptions/distractions\", and [PERSON] [31] assesses it in the EL domain through the items \"I was frequently interrupted\" and \"noise made it difficult to concentrate\". [PERSON]'s instrument [31] also assesses what experts know as professional behavior, and [PERSON] [5] reports that individual behavior during handover proved to be the key to the correct reception of messages. [PERSON] [31] includes this section in the EL domain through the items \"the other clinician used jargon out of context\", \"I was self-conscious due to who was present\", \"I was thinking about things unrelated to the sign-out\", and \"I found it difficult to focus my attention on the handover\". However, neither [PERSON] [24] nor [PERSON] [29] mentioned this section while discussing their instruments.