Developing a safer handover protocol for critically ill patients
When a critically ill patient moves between hospitals, clinical risk can rise quickly. A transfer may involve emergency department teams, intensive care clinicians, paramedics, retrieval specialists, ward staff and receiving consultants, all working across different systems. A standardised handover protocol gives these professionals a shared method for communicating essential information before, during and after the journey.
In Australia, interhospital transfers commonly connect metropolitan services with regional and remote hospitals. A patient may travel from Logan or Ipswich to Brisbane, from Toowoomba to the Princess Alexandra Hospital, or from Cairns to Townsville or another specialist centre. Each transfer has its own clinical pressures, yet the information exchange should remain consistent.
The protocol should support clinical judgement rather than replace it. Its purpose is to reduce omissions, clarify responsibility, identify deterioration early and ensure that the receiving team can act immediately. Research translation partnerships such as Brisbane Diamantina network can help bring clinicians, researchers and health services together to test whether a handover model improves patient outcomes.
A reliable process also needs to fit Australian practice. It must work during a busy evening shift, through Queensland’s wet-season disruptions, across limited regional mobile coverage and within the requirements of the National Safety and Quality Health Service Standards. The best design is brief enough for urgent use, detailed enough for complex cases and flexible enough for adult, paediatric and neonatal transfers.
Why transfer handover needs a common structure
Verbal reports can vary greatly depending on who is speaking, how familiar the receiving clinician is with the case and how much time is available. Important details may be buried in a long narrative: a difficult airway, a recent vasopressor change, a pending blood result or a family decision about treatment goals.
A standard format creates a predictable sequence. A practical model can begin with patient identification and the reason for transfer, followed by current assessment, treatment provided, response to treatment, risks during transport and actions required on arrival. This structure supports closed-loop communication, where the receiving clinician repeats critical instructions and confirms ownership of outstanding tasks.
The core information every handover should contain
The first part of the protocol should use an agreed clinical framework such as ISBAR: Identify, Situation, Background, Assessment and Recommendation. Identification should include the patient’s full name, date of birth, medical record number, allergies, location and nominated decision-maker where relevant. The transfer reason and urgency should be stated in plain language.
Assessment should cover airway, breathing, circulation, disability and exposure, with current observations and trends rather than isolated numbers. The handover should include oxygen or ventilator settings, intravenous access, infusions, analgesia and sedation, antimicrobial treatment, recent procedures, investigations, blood products and escalation plans. The recommendation should specify what the receiving team must do in the first minutes after arrival.
A written or electronic summary should accompany the verbal report. It should include medication charts, pathology, imaging, consent documentation, advance care planning records and contact details for the referring clinician. The electronic medical record can reduce duplication, but staff should have a downtime process when systems are unavailable.
Designing the protocol around the transfer journey
Handover should occur at defined points rather than being treated as a single conversation. The referring team should provide a pre-departure report to the retrieval service, the transport team should receive an updated report at departure, and the receiving unit should be contacted before arrival when the patient’s condition is unstable. A final bedside handover should take place at the destination.
Responsibility must be explicit. The referring doctor remains accountable for safe preparation until the retrieval team accepts the patient, while the retrieval clinician leads care during transport. At arrival, the receiving consultant or senior nurse confirms acceptance and records any immediate changes. These boundaries prevent assumptions, especially when the patient travels by road ambulance, helicopter or fixed-wing aircraft.
The protocol should account for Australian geography and transport conditions. Long road journeys between regional centres may require extra medication, battery and oxygen planning. Air transfers can be affected by weather, aircraft weight limits and aircraft changeovers. In rural and remote areas, teams may rely on the Royal Flying Doctor Service or retrieval coordination centres, so the handover must remain usable through telephone or radio communication when internet access is unreliable.
Making communication safe for patients and families
Families and carers often hold information that is absent from the clinical record, including baseline cognition, medication routines, cultural preferences and changes noticed before admission. Where the patient cannot speak for themselves, the handover process should identify who has been informed, what has been explained and whether an interpreter or Aboriginal and Torres Strait Islander liaison service is required.
Privacy and consent must be built into the workflow. Information should be shared only with people involved in care and handled consistently with the Privacy Act 1988, relevant Queensland requirements and local health-service policy. A documented contact person reduces repeated calls to distressed relatives and helps the receiving team continue discussions about treatment limits or deteriorating prognosis.
Patient-centred transfer also means recognising that communication needs differ. A child transferred from a regional hospital may require details about feeding, weight-based medication and parental presence. An older person may need information about delirium, mobility and usual function. Linking clinical safety with community partnership principles can help services design handovers that reflect the needs of families and local communities.
Testing, measuring and improving the process
Before implementation, hospitals should observe current handovers and identify common failure points. Staff interviews, case reviews and audits can reveal whether allergy status, escalation plans, infusions or pending results are frequently omitted. The protocol should then be tested in simulation with intensive care, emergency, retrieval, nursing, allied health and ambulance staff.
Measures should include the percentage of transfers with a completed checklist, the frequency of medication discrepancies, delays caused by missing information, unplanned clinical deterioration during transport and the time taken to achieve clinical acceptance. Patient and family feedback can add a vital perspective. Data should be reviewed by a multidisciplinary governance group rather than used to assign blame.
Education needs to be practical. Short sessions during shift overlap, laminated prompts in transfer areas and electronic templates can support adoption. Services should also make the protocol available to private hospitals, ambulance providers and smaller regional facilities involved in the local transfer network. International resources, including clinical knowledge exchange, may offer useful ideas, but every tool should be adapted to Australian terminology, legislation and workflows.
Governance and clinical sustainability
A transfer protocol should sit within the hospital’s clinical governance system, with a named owner, review schedule and process for reporting hazards. Changes to medication systems, electronic records, retrieval arrangements or national standards should trigger a review. The document should state when a full handover is mandatory and when an abbreviated emergency format is acceptable.
Research and implementation teams can examine whether the protocol improves continuity across intensive care, emergency medicine, trauma, maternity and paediatric services. Queensland-led research in other health areas, such as Queensland-led nutrition research, shows the value of connecting local evidence with practical improvements in care.
A sustainable model is concise, regularly practised and supported by leaders. It gives clinicians a shared language without preventing escalation when a patient’s condition changes. Most importantly, it treats handover as a clinical intervention: a deliberate step that protects information, decisions and accountability during one of the most vulnerable points in a patient’s care.
Health services can begin by mapping their current transfer pathway, agreeing on a minimum dataset and testing the draft protocol with frontline teams. Build the final version around measurable safety outcomes, patient and family experience, and the realities of Australian retrieval medicine.
