The handover that fails is rarely the one missing a result. It is the one that transmits a complete account of the last four hours without transmitting the concern that prompted them. The oncoming clinician inherits a tidy summary, no anxiety, and no reason to go and look.
Say the worry out loud and make it specific: what you think might be happening, what would confirm it, and what the patient would look like if it were. "Abdominal pain, bloods normal, awaiting review" and "I cannot explain why his lactate is 3.2 and I want it repeated in an hour" describe the same patient and produce entirely different behaviour. If you have no worry, say that too — an explicit "I am not concerned about this one" is information, and it tells the next clinician where not to spend their attention.
- State your leading concern before the narrative, not after it
- Name the specific finding that would confirm or refute it, and when to look
- Say explicitly when you are not worried — that is information too
- Hand over pending investigations with who is chasing them, by name
- Do the handover where the oncoming clinician can see the patient, not at a desk around the corner
Why it matters
A handover transmits facts reliably and worry badly, and it is the worry that generates the next review.
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