# How Clinicians Make Patient Care Handoffs Safer - Published: 2026-11-10 - Author: [Doctors Magazine](https://doctorsmagazine.co/author/doctorsmagazine-co.md) - Topics: [Q&A](https://doctorsmagazine.co/qa.md) - Source: https://doctorsmagazine.co/qa/how-clinicians-make-patient-care-handoffs-safer/ - Publication: Doctors Magazine - Publisher: Connectively (Terkel, Inc.) - Editorial policy: https://doctorsmagazine.co/editorial-policy/ - AI use: The perspectives in this article were written by the named contributors and submitted through Connectively. Connectively's automated system selected them and used AI to write the headline, introduction, section headings, summary sections, and illustration, and to make minor edits for clarity. Articles are assembled and published automatically. Report errors to corrections@connectively.us. ### Name Every Pending Item's Owner The detail I always communicate is what is still pending and who owns it. Confusion and duplication both start there. The next clinician can read what happened, but the chart rarely tells them what is waiting, and a waiting item is the one most likely to fall through. In practice that means a short list at the top of every handoff. Which biopsy or lab is outstanding, and when the result should arrive. Which treatment I started, and how long it needs before anyone judges it. Which treatment I stopped, and why. A clinician who sees that a patient has used a topical steroid for three weeks without improvement avoids prescribing the same one again, and a clinician who sees a biopsy still out avoids reassuring the patient too early. The second thing I state is the reason a treatment failed. A patient who stopped isotretinoin because of dry lips has a different story from a patient who stopped it because of a mood change, and the next prescriber must know which. A bare entry saying discontinued invites someone to restart a drug that harmed the patient. I finish by naming one person who owns the next step, with a date. Shared ownership means no ownership. When I write that Dr. X reviews the pathology on Friday, the patient and the team both know who to call, and duplicate testing and lost results drop. --- ### Document Evidence Behind Each Decision 1) In menopause care, I often prescribe in ways that are well supported by recent research but haven't reached every clinician's training or every standard protocol yet. One example is starting hormone therapy for a woman in perimenopause who is still having periods. My patients usually see other physicians too, such as their gynecologist, primary care doctor, or oncologist, and many of those physicians had little or no menopause training. Some are understandably cautious about these medications. So I never leave it to the patient to defend my treatment plan. I write a detailed narrative of what I prescribed and why, and I cite the studies behind each decision. That narrative goes to the patient and, with her permission, to her other clinicians. I also tell her up front that another doctor may disagree with what I've ordered, and that disagreement doesn't mean anything is wrong. It usually means that physician hasn't seen the newer evidence. A patient shouldn't be stuck in the middle of a debate between her doctors. 2) The rationale, not just the prescription. A medication list tells the next clinician what I did. It doesn't tell them why. Without the why, a perfectly reasonable plan looks like an error and gets stopped, or tests get repeated. Every handoff I write spells out three things: why I chose this treatment, with the evidence; what I'm monitoring and when; and which parts of her care I'm managing versus what I'm asking her other physicians to keep managing. That last part prevents most of the duplication. Clear ownership of each piece of her care is what keeps a woman from falling through the cracks. --- ### Define Next Steps and Deadlines When a patient's care moves between clinicians, I make sure the handoff explains more than just the diagnosis. In ophthalmology, I include the reason for the referral, important examination findings, treatment already provided, and any tests that are pending. This helps the next clinician understand what has been done and what still needs attention, without repeating unnecessary tests or leaving the patient confused. The detail I always emphasize is who is responsible for the next step and when it needs to happen. For example, if a patient is referred for further evaluation of glaucoma, I make it clear whether the receiving clinician needs to confirm the diagnosis, review test results, or decide on treatment. I also explain the plan to the patient so they know what to expect. I've found that a handoff works best when everyone understands not only the patient's condition, but also what happens next and who will follow through. --- ### Record Treatment Responses Precisely Alan Silberberg, MD Board Certified By The American Board Of Anesthesiology In Pain Medicine And Anesthesiology Greater Austin Pain Center, Austin, TX Most of my patients arrive from another clinician: a primary care physician, an orthopedist, a surgeon, or after an accident. Many have already been through several hands. The biggest risk at every handoff is that the next person starts over, repeating tests and retrying treatments that already failed. To the patient, that feels like nobody is listening. The detail I always communicate is what has been tried and exactly how the patient responded. "Had an injection" isn't useful. "Lumbar epidural steroid injection, roughly 60 percent relief for about six weeks, then pain returned to baseline" tells the next clinician what that result means and what to consider next. Response data like that is often the most valuable information in the whole chart. The second habit is stating clearly who owns what going forward: who manages medications, who orders the next imaging, and who the patient should call if symptoms change. Duplication and confusion usually happen in the gaps where two clinicians each assume the other is handling something. On the receiving end, I make a point of reviewing outside records and imaging before ordering anything new. It saves patients time and cost, and it tells them their history matters. --- ### Confirm Follow-Up Accountability The objective of a good handoff is to ensure that the receiving clinician has an accurate and complete understanding of the patient's medical issues, and what has been and what still needs to be done for their continued care. I do this in a succinct and consistent format because I have found that important information can get lost in the "sea" of a long handoff. I summarize the working diagnosis, recent changes in the patient's clinical status, pertinent test results, medications given, and outstanding studies or workup. I always find out what questions the receiving clinician has, if any, before finalizing the handoff because I do not consider the handoff complete until I am confident that the receiving clinician not only has received, but also understands, the information needed to assume care of the patient. I'd always find out what needs to happen next and when and who is responsible for doing a specific procedure or follow-up. It is important to identify warning signs that require immediate attention. In clinical care it is helpful to know what has happened to a patient, but there is often uncertainty about the results of tests, medication changes, and changes in symptoms that could delay getting necessary care. For me I always prioritize identifying who is responsible for follow-up and make sure that urgent concerns have been addressed so that two clinicians aren't assuming that the other will take action. --- ### Anchor Withdrawal Care to Timing In a detox setting the detail I always communicate is time: when the patient last drank or used, and when they last received withdrawal medication. Without it, every other observation is misleading. "Calm and stable" means something very different on the first evening than at 48 to 72 hours after the last drink, when the risk of severe alcohol withdrawal and delirium is highest. A patient who looks settled in the morning can be the one who becomes confused at night. So the receiving clinician needs to know where the patient is on that timeline, not just how they look at the moment of handover. The second thing I always pass on is the trend rather than the snapshot. A withdrawal score of 10 that was 18 this morning is reassuring. The same score that was 4 this morning is a warning. Experience has taught me that most handover mistakes are not missing facts, but facts without direction. --- ### Honor Client Commitments The biggest confusion during the handoff occurs when the next clinician has to figure things out independently. So I approach handoffs as transfers of ownership. Outgoing and incoming clinicians should communicate directly and assign clear responsibility for each open item, such as the next appointment, pending referral, or medication management follow-up. This ensures tasks are neither duplicated nor overlooked. I always confirm what the client has already been told to expect. If a client has heard "we'll be starting family sessions next week" or "we'll be revisiting your IOP schedule once you're back at work," and the next clinician is unaware, the client may perceive this as a broken promise. In behavioral health, trust is central to treatment. While diagnosis and history are documented in the chart, our commitments to the client often are not. In my experience, this is where handoffs most often break down. --- ### Close Every Unresolved Loop When patient care transitions between clinicians, I approach the handoff as a formal transfer of clinical responsibility rather than a routine update. An effective handoff should be concise, structured, and actionable, clearly communicating four essential elements: the patient's active clinical problems and treatment rationale, interventions completed to date, outstanding tests or decisions with anticipated timelines, and explicit accountability for each pending action. The final element is particularly important, as ambiguity surrounding responsibility often leads to duplicated testing, delayed follow-up, and gaps in care. The most critical information I communicate involves what I consider "open loops" - diagnostic evaluations, treatments, or clinical decisions that have been initiated but remain unresolved. Rather than simply documenting that a test is pending, I specify when it was ordered, its clinical significance, and the anticipated next steps. For example: "Lipoprotein(a) ordered October 21; result pending. If elevated, reassess cardiovascular risk and consider intensification of lipid-lowering therapy." This provides the receiving clinician with both the necessary context and a clear framework for subsequent decision-making. While problem lists and medication reconciliations are essential, they primarily reflect a patient's clinical status at a single point in time. Open loops provide something equally valuable: insight into the trajectory of care, including the reasoning behind prior decisions and the intended direction of management. Communicating this trajectory allows the receiving clinician to maintain continuity, avoid unnecessary duplication, and preserve clinical momentum. Finally, I emphasize closed-loop communication. Whenever feasible, the written handoff is supplemented by a direct verbal exchange or secure message, with the receiving clinician acknowledging the transfer and confirming responsibility for outstanding items. This brief confirmation helps identify discrepancies in understanding before they translate into delays or errors. Ultimately, an effective handoff is not simply the transfer of information; it is the explicit transfer of accountability, ensuring that every unresolved clinical issue has a clearly identified owner and a defined plan for follow-up. ## Related - [Clinical Handoffs That Keep Patient Care Continuous](https://doctorsmagazine.co/qa/clinical-handoffs-that-keep-patient-care-continuous.md) - [Make Hospital Discharge Stick: Hospital-to-Clinic Handoffs That Cut Confusion](https://doctorsmagazine.co/qa/make-hospital-discharge-stick-hospital-to-clinic-handoffs-that-cut-confusion.md) - [What Strategies Ensure Clear Communication Within a Multidisciplinary Team?](https://doctorsmagazine.co/qa/what-strategies-ensure-clear-communication-within-a-multidisciplinary-team.md) - [How Healthcare Teams Strengthen Patient Care Handoffs](https://doctorsmagazine.co/qa/how-healthcare-teams-strengthen-patient-care-handoffs.md)