Effective communication remains one of the most important factors to patient safety and organization in any hospital department. Accident and Emergency with its high levels of acuity remains an area at great risk for communication breakdowns. Breakdowns in communication increase errors and can interrupt the general flow of the ward causing disorganization and adverse patient outcomes. Handover from one shift to the next is a time where communication errors are at their highest. This paper takes a look at some of the barriers that can impede communication during handover in a busy Accident and Emergency department in Rwanda and how it identified the problem and came up with a solution to improve communication between shift leaders. It discusses in depth the steps that were taken to create a handover tool that was adopted in the department.