Handover is the most important 10–15 minutes of your entire on-call shift.

A good handover makes the night calm and controlled.
A bad handover creates missed sick patients, constant bleeps, and unsafe care.

This isn’t a formality — it’s a patient safety task.

Your aim is simple:

Leave handover knowing exactly who is sick, what needs doing, and what might go wrong.

What usually goes wrong

Common problems juniors face:

Jobs written vaguely (“review patient”)
No idea who is unwell
No prioritisation
Discovering emergencies at 2am that were known at 5pm
Spending the night firefighting

Most of this is preventable with a structured approach.

Arrive early (non-negotiable)

Turn up 10–15 minutes early.

Not to be keen — but to be safe.

You need time to:

log into computers
open bloods/imaging
prepare your jobs sheet
settle mentally

Starting rushed = unsafe decisions later.

What you must find out (every shift)

During handover, actively look for these answers.

Don’t just passively listen.

🔴 1. Who is sick right now?

This is the single most important question.

Ask clearly:

“Which patients are you worried about tonight?”

Examples:

septic patient
GI bleed
DKA
confused elderly with falls
NEWS ≥5
anyone borderline for HDU/ICU

Write these names at the top of your list.

These are your first reviews.

Everything else is secondary.

🟠 2. What jobs are time-critical?

Separate urgent vs routine.

Urgent

review unwell patient
blood transfusion
insulin/DKA management
antibiotics
urgent scans
escalating oxygen

Routine

discharge letters
rewriting drug charts
non-urgent bloods
paperwork

Do not mix these together.

🟡 3. What might deteriorate overnight?

Think proactively.

Ask:

“Anyone likely to crash or need review later?”

Examples:

rising lactate
borderline BP
worsening AKI
new oxygen requirement
post-procedure patients

These are the patients that generate 3am bleeps.

Know them early.

🟢 4. Outstanding results or plans

Clarify:

pending CTs
pending bloods
cultures
specialist reviews awaited
plans from day team

Otherwise you’ll waste time re-figuring everything overnight.

🟣 5. Ceilings of care / DNACPR

Very important and often missed.

Know:

who is for escalation
who is ward-based only
who is not for ICU

Because decisions at 3am depend heavily on this.

Never guess ceilings.

How to structure your job list

Don’t write randomly.

Organise like this:

🔴 Sick patients first

🟠 Urgent tasks

🟡 Routine jobs

This prevents you doing paperwork while someone deteriorates.

Simple system → safer decisions.

Clarify responsibility

Always check:

Which wards are you covering?
Who is the registrar?
Who covers cross-cover wards?
How to contact ICU/outreach?

Nothing worse than wasting 10 minutes finding the right number during an emergency.

Save numbers early.

Introduce yourself to nurses early

After handover:

Go to each ward briefly:

“Hi, I’m the on-call SHO/Reg tonight. Anyone you’re worried about?”

Nurses often know the sickest patient before the notes do.

This one habit prevents many late-night surprises.

What juniors often miss

Common mistakes:

❌ accepting vague jobs
❌ not asking “who is sick?”
❌ mixing routine with urgent
❌ starting paperwork first
❌ discovering problems hours later
❌ not checking ceilings of care

Most on-call stress comes from these, not medicine itself.

A simple 5-minute checklist

Before leaving handover, you should know:

✅ Who is sick
✅ Who might deteriorate
✅ Urgent jobs
✅ Outstanding results
✅ Escalation plans
✅ Registrar contact

If you don’t know these → ask again.

Take-home concept

Handover is not admin.

It is risk management.

If you start your shift knowing exactly:

who to see first
what matters most
what can wait

You’ll feel calmer, safer, and more efficient.

Most good on-call shifts start with a good handover.