At hospital shift changes, doctors and nurses exchange crucial information about the patients they’re handing over—or at least they strive to. In reality, they might not spend enough time talking about the toughest cases, according to a study led by the University of Michigan.

These quick but important handoff conversations can have a major effect on patient care during the early parts of a shift. More than a half billion of them happen in U.S. hospitals every year, and that number has substantially increased with enforcement of work-hour regulations. Studies have shown that miscommunication during handoff conversations is a major contributing factor in preventable medical errors.

The new analysis of 23 handoff sessions involving 262 patients at a Canadian hospital revealed that doctors tend to use excessive time on early cases and rush at the end of the list, even though the last cases on the list might warrant more of their conversation time. The study authors suggest that doctors should talk first about the patients that require the most discussion.

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