You have just given the most thorough handoff of your career. Detailed history, complete vitals trending, mechanism of injury, treatments given, response to interventions. Five solid minutes of clinical gold.
The nurse nods, types something into the computer, and asks: “So what’s the chief complaint?”
Sound familiar?
Why Your Handoffs Get Ignored
It is not that ED staff do not care. They are triaging three other patients in their head, the doc is asking about the chest pain in room 4, and your chronological masterpiece just became background noise. The problem is not your content—it is your structure.
The harsh truth: You have about 10-15 seconds of full attention before they start multitasking. Use them wisely.
The Front-Loaded Handoff
Lead with the sick part. Always. Here is what works:
First 10 seconds (the hook):
- “This is a 58-year-old diabetic with new-onset confusion and a lactate of 4.2—I’m worried about sepsis.”
- “72-year-old on blood thinners, ground-level fall, GCS was 13 on scene and is now 10.”
- “34-year-old asthmatic, three nebs and still speaking in two-word sentences.”
What NOT to lead with:
- “We got called to 123 Main Street for a wellness check…”
- “Patient has a history of diabetes, hypertension, COPD, CHF…”
- “So dispatch sent us for an unknown medical…”
The Magic Phrases
Certain phrases make people stop and listen:
- “I’m worried about…” — This signals clinical concern, not just a taxi ride
- “This changed during transport…” — Indicates an active process
- “This is different from their baseline…” — You did your homework
- “I think this needs…” — You have a clinical opinion worth hearing
Compare: “Patient reports chest pain” vs “I’m worried this is an inferior MI—he’s got ST elevation in II, III, and aVF with reciprocal changes.”
Know When to Stop
If they are already moving on, do not chase them with more information. Instead:
- Document everything thoroughly on your PCR
- Offer: “I’ll be at the nurses’ station if you have questions”
- For critical findings, directly address the physician
The Pearl
Lead with the sick part in the first 10 seconds. If you bury your clinical concern in a chronological history, you have already lost them. “I’m worried about…” is the most powerful phrase in your handoff vocabulary.
This clinical pearl is for educational discussion only. Effective communication is a skill that improves with practice. Your local facility may have preferred handoff formats—when in doubt, ask what works best for them.