Synopsis
Transfer clinical information, responsibility and contingency plans reliably across people and settings using prioritisation, structured dialogue, read-back and closed-loop ownership.
- Handover transfers responsibility as well as facts; identify the sender, receiver, time, location and point at which responsibility changes.
- Prioritise unstable patients and time-critical tasks first, while ensuring every patient on the agreed list is accounted for.
- Use a structure such as SBAR flexibly: situation, relevant background, current assessment and an explicit recommendation or task.
Reasoning priorities
Match identifiers, current location and responsible service against the live record.
Resolve missing, duplicated, discharged or transferred patients before clinical tasks are assigned.
Worked reasoning
A patient had melaena and transient hypotension. They are currently stable; repeat haemoglobin is due at 20:00 and endoscopy is planned for morning.
- Place the patient early in handover, confirm identity, current location, observations, access and that the receiver knows how to summon immediate help if bleeding recurs.
- Give a concise SBAR: Situation—recent melaena with transient hypotension, now stable; Background—suspected upper gastrointestinal bleeding and morning endoscopy plan; Assessment—rebleeding remains possible despite current observations; Recommendation—receiver reviews both the patient and the 20:00 haemoglobin.
- Name immediate escalation triggers rather than saying 'if worried': new haematemesis or melaena, syncope, hypotension, tachycardia, rising early-warning score or a clinically important haemoglobin fall. State the agreed route to the medical registrar, gastroenterology or resuscitation team according to severity.
- Ask for read-back of the timing and triggers, document acceptance and pending endoscopy requirements, and verify during the shift that the result was reviewed and acted upon.