The first time I watched a colleague hand over his ward, it was 2:18 a.m. He had a folded sheet of paper in his coat pocket — names, bed numbers, two-letter shorthand. Twenty-seven patients. He spoke at the speed of someone who had done this for years, but I could see him glance at the paper between every patient. The handover took eighteen minutes. By the end, the doctor receiving it was already reaching for his own folded sheet.

That was the moment that made me believe the ward needed software of its own.

I went home and started counting. Eighteen minutes is about forty seconds per patient. Forty seconds per patient is not enough to convey what is happening on the ward to a doctor who has never seen the patients. Forty seconds is enough to convey the urgent thing about this patient. Anything else gets dropped.

The handover protocol literature (Starmer et al., NEJM, 2014; Riesenberg et al., Am J Med Qual, 2009) recommends a structure: illness severity, patient summary, action list, situation awareness, synthesis. The recommendation, applied across twenty-seven patients in eighteen minutes, would consume the entire handover in the structure alone, with no time for content.

So real handovers strip down to two things per patient: what is happening now, and what is pending. That is the I-PASS bundle when you remove the parts that don't fit in forty seconds.

The Medows handover composes itself in exactly that shape: "Now" and "Pending" per patient, drawn from the actual events of the shift. Two lines. The receiving doctor reads them in less than twenty seconds. Twenty seconds per patient × twenty-seven patients = nine minutes of handover. Half the time of paper.

The half-time isn't the point. The point is that the time saved isn't spent on more administrative work. It is spent on the patients that need more than forty seconds — the one that is deteriorating, the one whose family is asking hard questions, the one whose CT just got read.

A handover should be a triage of attention. The folded-paper version is a triage of which patient gets mentioned. The auto-composed version is a triage of which patient needs your time. The difference matters at 2:18 a.m. when the next twelve hours are going to decide outcomes.