Handoffs are moments of critical transition in which clinicians engage to maintain continuous coverage of patient care. This paper reports on an observational study of continuous coverage in an Emergency Department (ED), where three types of handoffs that occur during the same shift were identified: lunch breaks, ad hoc breaks and high workloads. The findings show these “in-shift handoffs” are managed not only through temporal linear coordination, but also through the local coordination among nurses working nearby. In-shift handoffs are crucial to maintaining continuous coverage in hospital settings.However,insufficient understanding of in-shift handoffs in Electronic Medical System (EMR) design may lead to a separation of information and responsibility, and an illusion of communicationin patient care.The findings of this study call for attention to in-shift handoffs in future system design and for improving the traditional handoff process through the coordination of local awareness during ED work.