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Development ServicesWhy shift handoff is one of the riskiest moments in a hospital, and what it took to build a tool that supports nurses through it.
13 May 2026
At Intersog, the projects we’re most proud of are the ones where the founder knows the problem from the inside. Not from a market report or slidedecks, but from doing the work, every shift, for years.
ShiftGuard is one of those projects.
Its founder, Levi Knudson, spent roughly 15 years as a registered nurse, most of it in the Emergency Room (ER), before deciding that the most fragile moment in a hospital shift, the handoff between nurses, deserved a better tool than memory and scattered notes. He brought the idea to our team, and together we shaped it into a working MVP designed for real clinical use.
We sat down with Levi to talk about what nurses actually face during shift change, why the EMR alone isn’t enough, the design choices that made HIPAA compliance easier rather than harder, and what hospitals can expect as ShiftGuard moves from the MVP into pilots.
- Levi, you’ve worked as a nurse yourself for quite a long time. What did shift handoffs actually look like on the floor?
Levi: I’ve worked as a registered nurse for about 15 years, mostly in the ER, so handoff is something I’ve lived every shift. In the real world, it isn’t always a quiet, organized conversation. It happens while call lights are going off, new patients are arriving, family members are asking questions, physicians are giving orders, and nurses are trying to finish tasks before leaving. Most nurses care deeply and are trying to do the right thing, but the environment makes it easy for important details to be missed. Handoff often depends on memory, personal habits, and whatever notes a nurse had time to write down. That variability is the problem ShiftGuard is trying to solve.
- Was there a specific moment that sparked the idea? A point where you thought, “This is broken, someone needs to fix it”?
Levi: The idea came from watching the same problem repeat itself, shift after shift. A nurse would give a report with the best intentions, but something important would still get left out because the handoff was interrupted, rushed, or unstructured. In the ER especially, the next nurse may be walking into a high-acuity patient, pending labs, high-risk medications, family concerns, or a patient who is about to deteriorate. I remember thinking that we keep expecting nurses to carry all of this in their head during one of the busiest moments of the shift. That felt broken to me. I wanted to build something that supported the nurse in real time, not added another burden.
- What does it feel like to pass a patient off, knowing some critical detail might get lost?
Levi: It creates a lot of pressure, because nurses know that one missed detail can change the next few hours of care. It might be a pending critical lab, a medication that still needs to be given, a fall risk, a change in mental status, a family concern, or a provider plan that was discussed but not clearly passed on. Even when nothing bad happens, the receiving nurse can lose valuable time trying to reconstruct the patient story. Communication breakdown is a known patient-safety risk in healthcare, especially during transitions of care. The issue is not that nurses don’t care. It’s that handoff often happens in a chaotic environment without a consistent support system to make sure key elements are covered every time.
- But nurses already use EMRs. Why wasn’t that enough?
Levi: The EMR is essential, but it was never designed to be a real-time nurse-to-nurse handoff assistant. The chart contains a large amount of information, but that doesn’t automatically turn into a concise, prioritized handoff. Nurses still have to decide what matters most, organize it, say it clearly, and make sure nothing critical is missed. The gap is between the documentation and communication. ShiftGuard is designed to support that moment. It doesn’t replace the EMR: it helps the nurse structure the verbal handoff so the receiving nurse can quickly understand what’s going on, what’s pending, and what needs attention next.
- When did you go from “this is a problem” to “I’m going to build the solution”?
Levi: The shift happened when I realized this wasn’t just my personal frustration; it was a recurring workflow problem affecting nurses, patients, and hospital leaders. Hospitals invest enormously in quality, safety, throughput, and adverse-event prevention, yet the actual bedside handoff often still relies on memory and habit. My confidence came from being close to the problem. I know the pace of the ER, I know what nurses need, and I knew the solution had to be simple, fast, and built around real nursing workflow. That nurse-led perspective is what made me believe ShiftGuard could be different from a generic documentation tool.
Working With Shiftguard
- Walk us through what a nurse’s experience looks like with ShiftGuard — from clocking in to handing off a patient.
Levi: The goal is for it to feel simple and natural. A nurse opens ShiftGuard and sets up the patients they’re caring for. During the shift, the tool helps capture the important elements of handoff in a structured way. When it’s time to give a report, ShiftGuard helps the nurse organize the patient story around key clinical categories, instead of relying only on memory or scattered notes. The receiving nurse gets a clearer, more consistent handoff focused on what matters: patient status, risks, pending items, medications, plan of care, and anything that needs follow-up. The product is meant to support the nurse during a high-risk transition, not slow them down.
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- ShiftGuard doesn’t store patient data. Was that a deliberate design decision from day one — and why does it matter?
Levi: Yes, that was intentional. From the beginning, I wanted ShiftGuard to be easy for hospitals to evaluate and pilot without creating unnecessary privacy, integration, or implementation barriers. The product is not meant to become another medical record, and it isn’t trying to compete with the EHR. By avoiding patient data storage and not requiring EHR integration for pilot use, ShiftGuard can focus on the handoff workflow itself - structure, consistency, and reliability. Hospitals are cautious about new technology, especially anything involving protected health information. Keeping the design lightweight reduces risk and makes early adoption realistic.
- Which hospitals or units is ShiftGuard best suited for today?
Levi: Today, ShiftGuard is ideal for inpatient hospital units where nurse-to-nurse shift handoff follows a more structured and repeatable workflow. The Emergency Department is an important area of care, but ShiftGuard isn’t currently designed as an ER-specific tool — the ED operates in a uniquely fast-moving, interruption-heavy environment with a different rhythm of patient turnover and handoff.
The strongest fit today is in units like med-surg, telemetry, ICU step-down, observation, behavioral health, rehabilitation, and other inpatient or specialty areas where nurses are managing multiple patients and need a consistent, reliable report structure. In these environments, ShiftGuard can support safer transitions of care, reduce missed handoff elements, improve communication consistency, and give nurses a clearer framework during shift change.
The best initial hospital fit is any unit where leaders are focused on patient safety, communication reliability, nursing efficiency, and reducing preventable gaps during handoff.
- What does onboarding look like for a new hospital or unit? How long until nurses feel comfortable with it?
Levi: Onboarding is intentionally light. For a pilot, we introduce the tool, explain the workflow, demonstrate how it supports SBAR-style handoff, and let nurses practice with it in a realistic scenario. Because the product is built around how nurses already think and communicate, the learning curve is short. A nurse should be able to understand the basic workflow in a brief training session and become more comfortable after using it across a few shifts. The key is positioning it as a support tool, not another documentation requirement.
- Are there metrics you’re tracking to demonstrate impact?
Levi: The planned pilot metrics focus on practical, measurable indicators: nurse usability, perceived handoff completeness, confidence in receiving report, missed follow-up items, time spent preparing or clarifying report, and overall workflow fit. Over time, the goal is to study whether a structured handoff assistant can reduce communication gaps, improve nurse efficiency, and support patient-safety outcomes. The first step is proving that nurses will actually use it and that leaders can see measurable improvement in handoff reliability.
Successful Partnership
- When you decided to build ShiftGuard, why did you choose to work with an external development partner rather than building in-house?
Levi: I had the clinical experience and the workflow vision, but I knew I needed a technical partner who could help turn that into a functional product. Building in-house would have required hiring and managing a full development team before the concept was even proven. Working with an external partner let me move faster, stay focused on the nursing workflow, and collaborate with people who already understood product development, architecture, and execution. For an early-stage healthcare product, speed and focus mattered more than headcount.
- What were the biggest technical challenges in building ShiftGuard, especially around HIPAA and the “no patient data storage” requirement?
Levi: One of the biggest challenges was designing the product so it could support realistic nurse handoffs without becoming a place where patient data is stored long term. In healthcare, privacy and compliance have to shape the product from the beginning, not get bolted on at the end. The team had to think carefully about the workflow, what information is actually needed during a handoff, how the product behaves during use, and how to keep the MVP lightweight enough for pilot evaluation. Another challenge was keeping the interface simple enough for busy nurses. If a tool takes too many clicks or feels clunky, it won’t survive real workflow.
Because I’m not a software engineer, I needed a team that could explain options clearly and also understand why certain clinical details mattered. Intersog approached this with care and rigor. That mutual translation between clinical reality and software design is what made it work.
- Where is ShiftGuard today? Any early results you can share?
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Levi: ShiftGuard is currently at the MVP and early demonstration stage. The focus right now is getting the product in front of hospital quality and nursing leaders, gathering feedback, and preparing for pilot opportunities. So far, early progress has been encouraging because the problem resonates quickly with nurses and leaders who understand handoff risk. At this stage, the most honest result is that ShiftGuard has moved from an idea into a working product that can be demonstrated, tested, and evaluated in a real clinical environment.
- Have you heard any feedback from nurses testing the app?
Levi: The strongest theme is recognition. Nurses understand immediately why a structured handoff tool could help, especially in busy environments where reports can become rushed or inconsistent. The other consistent piece of feedback is that the tool needs to stay fast, simple, and useful inside a real workflow. Nurses don’t want another task. They want something that helps them organize the report, remember what matters, and feel more confident that the next nurse has the right information.
- What does “winning” look like for a hospital that adopts ShiftGuard?
Levi: A successful deployment means nurses actually use the tool because it makes handoff easier and more reliable. For a hospital, winning would look like more consistent reports, fewer missed handoff elements, less time spent chasing clarification after shift change, and greater nurse confidence during transitions of care. For leaders, it means having a practical way to support communication reliability without requiring a major EHR build or a heavy implementation. Ultimately, success means safer transitions for patients and a smoother workflow for nurses.
The Road Ahead
- Levi, where do you see ShiftGuard in two to three years? Are there other clinical workflows where this could apply?
Levi: In the next two to three years, I see ShiftGuard becoming a trusted handoff reliability tool for hospitals that want to improve patient safety and nurse efficiency without adding unnecessary complexity. The first priority is nurse-to-nurse shift handoff, but the same concept could apply to other high-risk communication points: ER-to-floor handoff, transfer reports, discharge readiness communication, break coverage, charge nurse updates, and possibly procedural or transport handoffs. The larger vision is to make clinical communication more structured, reliable, and easier for frontline staff.
- What would you say to a hospital administrator or CNO who’s skeptical about adopting another tool for their nurses?
Levi: I’d say the skepticism is valid. Nurses are already overloaded, and any new tool has to earn its place in the workflow. ShiftGuard isn’t designed to add documentation or replace what nurses already use. It’s designed to support one of the most important safety moments in the shift: handoff. The question isn’t whether nurses need another app. The question is whether hospitals can keep relying on memory, habit, and inconsistent report structures for such a high-risk transition. ShiftGuard is built to be lightweight, pilot-friendly, and focused on measurable handoff reliability.
- If a hospital is reading this right now and curious about ShiftGuard, what’s the best first step?
Levi: The best first step is a short conversation and a demo focused on the hospital’s current handoff process. I want to understand where communication gaps are happening, what leaders are trying to improve, and which unit would be the best fit for a small pilot. From there, we can review the workflow, show the MVP, and discuss whether a short, structured pilot would be valuable. Hospitals can also visit shiftguard.info to learn more and start the conversation.
ShiftGuard is a reminder of something we believe deeply at Intersog: the most useful healthcare products tend to come from the people closest to the problem. Our role is to help those founders move from clinical insight to a real, compliant, well-built product, without the months of overhead that often slow early-stage healthcare ideas down.
If you’re a founder, clinician, or healthcare leader with a problem worth building for, we’d love to talk.
