9 minute read
Signal over completeness
Good handover is ruthless triage of information: sick-or-not-sick, what is running tonight, what to do if X happens. A structured frame (identify, situation, background, assessment, recommendation) works because it forces the assessment and the contingencies to the front.
The receiving clinician's needs decide the content: they need actions and thresholds ('if the potassium at 22:00 is above 6, do Y'), not the admission story retold.
The if-then is the handover
Every anticipated overnight event deserves an if-then with numbers in it. Vague handovers ('keep an eye on him') delegate the thinking to the most tired person in the building at the worst hour.
Good if-thens have three parts: the trigger with a threshold ('if the 22:00 potassium is above 6'), the action ('give calcium gluconate and repeat the ECG'), and the escalation ('and call me; the renal team is aware'). The threshold does the receiver's triage for them; the escalation tells them they were expected to call, which is the difference between asking for help and admitting defeat.
Receiving is a skill too
The receiver's job is active: read back the if-thens in your own words, ask the two questions that expose soft spots ('what is the thing you are actually worried about with this patient?' and 'what would make you come back in?'), and re-sort the list by sickness before the giver leaves the room. Write the thresholds down where you will see them at 03:00, not where you wrote them at 21:00. A handover is a contract, and it is only signed when both sides hold the same model of the night.
Pearls
- Hand over the watch-fors, not the biography.
- A handover without a single if-then probably has not been thought through.
- Every if-then needs a threshold, an action, and an explicit permission to call.
- Read back what you received; the gap between what was said and what was heard is where patients get hurt.
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