# I-PASS Shift Handover: [Unit, date, shift]

> Structured written and verbal shift handover using I-PASS: Illness
> severity, Patient summary, Action list, Situation awareness and
> contingency planning, Synthesis by receiver. I-PASS was evaluated in
> Starmer AJ et al., "Changes in medical errors after implementation of
> a handoff program", N Engl J Med 2014;371(19):1803-1812, where a
> handoff bundle across nine paediatric residency programmes was
> associated with fewer medical errors and preventable adverse events.
> Replace every `[bracketed]` value and every row marked *Example*.
> This is a communication format, not medical advice; follow local
> policy and clinical judgement. Use fictional data in examples, and
> keep real handover lists inside your clinical system.

<!--
Guidance: How to use this template
- Use it for a planned transfer of responsibility for a group of
  patients: end of shift, end of a weekend block, or a team change.
  For a single urgent escalation, use SBAR (`healthcare/sbar`).
- Prepare the written part before handover and update it during the
  shift. The verbal handover follows the written order, sickest
  patients first.
- Hand over in a quiet place, face to face where possible, with
  interruptions only for emergencies.
- The receiver drives the last step: they summarise, ask questions and
  read back the actions. The giver confirms or corrects. Handover is
  complete only when this has happened.
- I-PASS works best as part of a bundle (training, written tool,
  observation and feedback), as in the published study. The name and the
  formal curriculum belong to their developers; this template is an
  original layout that follows the public mnemonic.
- Related templates: SBAR (`healthcare/sbar`), Progress Note
  (`healthcare/progress-note`), SOAP Note (`healthcare/soap-note`),
  Medication Reconciliation (`healthcare/medication-reconciliation`),
  Discharge Summary (`healthcare/discharge-summary`).
-->

## Document control

<!-- Guidance: One handover sheet per team per shift. Store it as your organisation requires: some keep the sheet as part of the record, others treat it as a working document that is destroyed securely after the shift. -->

| Field | Value |
|---|---|
| Document ID | [HO-YYYY-MM-DD-UNIT-SHIFT] |
| Unit / team | [Ward, service, team] |
| Shift | [Day / evening / night / weekend] |
| Giver | [Name, role, contact] |
| Receiver | [Name, role, contact] |
| Date / time of handover | YYYY-MM-DD HH:MM |
| Number of patients | [N] |
| Version | [1.0] |
| Status | [Prepared / Handed over / Read back confirmed] |
| Owner | [Giver] |
| Approvers/reviewers | [Not applicable for one shift / unit lead for a change to the sheet] |
| Last updated | YYYY-MM-DD HH:MM |
| Classification | [Confidential: patient information] |

### Revision history

| Version | Date | Author | Change |
|---|---|---|---|
| 1.0 | YYYY-MM-DD | [Name] | Sheet prepared for handover |
| 1.1 *(Example)* | YYYY-MM-DD | [Name] | Updated after receiver read-back |

## 1. Unit overview

<!-- Guidance: Thirty seconds on the unit before the patients: staffing, beds, expected admissions, any patient who is not on your list but might need you. Pitfall: starting patient by patient and forgetting the expected admission from the emergency department. -->

| Item | Detail |
|---|---|
| Staffing and gaps | [Who is on, who is missing, escalation contact] |
| Beds and expected admissions | [Free beds, expected arrivals] |
| Watchers and unstable patients | [Count, bed numbers] |
| Outstanding unit tasks | [Equipment, audits, safety issues] |

## 2. Illness severity

<!-- Guidance: Give one of three categories for every patient at the start of their handover, so the receiver knows where to look first. Re-categorise when things change. -->

| Category | Meaning | What the receiver should expect |
|---|---|---|
| Stable | Expected to stay well over the shift | Routine review |
| Watcher | Uncertain, at risk of getting worse | Planned check at a stated time, low threshold to escalate |
| Unstable | Getting worse or needs active intervention now | Immediate review, senior aware |

Order the patient list below as unstable first, then watchers, then
stable patients.

## 3. Patient handover entries

<!-- Guidance: One block per patient in the same order. Keep the patient summary to what the receiver needs tonight. The action list has owners and times. Contingencies are "if X, then Y" lines. -->

### Patient [bed or identifier]

| I-PASS element | Content |
|---|---|
| **I**llness severity | [Stable / watcher / unstable] |
| **P**atient summary | [Age, reason for admission, key problems, current treatment, relevant history, code or escalation status, allergies] |
| **A**ction list | [Task, owner, time due; mark each done or not done at the end of shift] |
| **S**ituation awareness and contingency planning | [What is happening now, and if [change], then [action]] |
| **S**ynthesis by receiver | [Receiver's summary, questions asked, actions read back] |

*Example:* fictional patient, bed 14, Ward 5, Halvermoor District Hospital.

| I-PASS element | Content |
|---|---|
| Illness severity | Watcher |
| Patient summary | 81 years old, admitted yesterday with community-acquired pneumonia, on intravenous antibiotics day 2 and 2 L oxygen. Background of heart failure and chronic kidney disease. Penicillin allergy (rash). For full escalation. |
| Action list | 1. Check potassium result from 18:00 sample, receiver, by 20:00. 2. Review fluid balance at 22:00, receiver. 3. Antibiotic level due 06:00, phlebotomy requested, giver has done the form. |
| Situation awareness and contingency planning | Breathing better than this morning. If oxygen need rises above 4 L or respiratory rate above 25, call the medical registrar and repeat chest X-ray. If potassium is above 6.0, follow the hyperkalaemia protocol and call the registrar. |
| Synthesis by receiver | Receiver repeated: watcher, check potassium by 20:00, fluid balance at 22:00, escalate if oxygen above 4 L or respiratory rate above 25. Asked whether diuretics were held today: yes, held at 08:00. Giver confirmed. |

Copy the block for each patient.

## 4. Verbal handover sequence

<!-- Guidance: The sequence shows who speaks at each step. The receiver's synthesis is a separate step, not a nod. -->

The giver leads the first five steps; the receiver leads the synthesis,
and the giver closes the loop before moving to the next patient.

```mermaid
sequenceDiagram
    participant G as Giver
    participant R as Receiver
    G->>R: Unit overview
    G->>R: Illness severity for the next patient
    G->>R: Patient summary
    G->>R: Action list with owners and times
    G->>R: Situation awareness and contingencies
    R->>G: Synthesis, questions and read-back of actions
    G->>R: Confirm or correct
    Note over G,R: Repeat for each patient, sickest first
```

## 5. Handover completion

<!-- Guidance: Record that the handover took place and that every unstable and watcher patient had a read-back. Pitfall: a handover cut short by an emergency that is never finished. -->

| Check | Done |
|---|---|
| All patients on the list handed over | [Yes / no: which remain] |
| Every unstable and watcher patient read back by the receiver | [Yes / no] |
| Action list transferred with owners and times | [Yes / no] |
| Interruptions | [None / emergency, handover resumed at HH:MM] |
| Giver available after handover until | HH:MM, contact [number] |

## 6. Quality checks for the unit

<!-- Guidance: Use these as observation items when the unit reviews its handover practice. Measure a sample of handovers, not every one. -->

| ID | Observation item | Target *(Example)* |
|---|---|---|
| HQ-01 | Illness severity stated for every patient | 100% of observed patients |
| HQ-02 | Every contingency written as "if, then" | 90% of watcher and unstable patients |
| HQ-03 | Receiver synthesis observed | 100% of watcher and unstable patients |
| HQ-04 | Handover finished without non-urgent interruption | 80% of observed handovers |

To test an improvement in these items, use a PDSA cycle
(`healthcare/pdsa-cycle`).

## References

<!-- Guidance: If your organisation uses a local variant of I-PASS, record its name and version here. -->

| Reference | Status | Use |
|---|---|---|
| Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med 2014;371(19):1803-1812, https://doi.org/10.1056/NEJMsa1405556 | Citation checked on PubMed (PMID 25372088), 2026-10-30 | Mnemonic and evidence: errors 24.5 to 18.8 per 100 admissions, preventable adverse events 4.7 to 3.3 per 100 admissions |
| I-PASS Patient Safety Institute, https://www.ipassinstitute.com/ | Checked 2026-10-30 | Developer's training and written handoff tool. Official materials: I-PASS Patient Safety Institute, licensed access via the same site |
| AHRQ TeamSTEPPS 3.0, Tool: I-PASS, https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/ipass.html | Not re-checked (site blocked automated access) | I-PASS as a team communication tool |

## Standard and licence note

Based on the public I-PASS mnemonic as published by Starmer et al.
(N Engl J Med, 2014). This template is original text written for this
collection and does not reproduce the I-PASS curriculum or the
developer's written handoff tool, which are available from I-PASS
Patient Safety Institute. All names, wards and clinical details in
examples are fictional. This is a communication format, not medical
advice; follow local policy and clinical judgement, and check the
current official pages. Template licence: MIT.