Patient & setting
Confirm the correct patient, current location, sender, receiver, and reason responsibility or advice is being transferred.
BH
Brooke Harbor Health System
PMHNP Clinical Learning Environment
Updated July 31, 2026
PMHNP Clinical Toolbox
Handoffs & Consultation
Communicate the patient’s current situation, clinical reasoning, uncertainty, safety needs, and next actions so responsibility and decision-making can move safely between clinicians.
Core content
Make the clinical picture actionable
Current situation
State what is happening now, why it matters, and whether the communication is routine, time-sensitive, or emergent.
Relevant background
Include only the history, diagnoses, medications, recent changes, results, and context needed to understand the current problem.
Assessment & uncertainty
Share your clinical impression, supporting evidence, safety formulation, response to treatment, and what remains unknown or unresolved.
Request or recommendation
Make the question, requested action, level-of-care need, or next decision explicit.
Tasks & contingencies
Name who owns each action, the expected timeframe, what should be monitored, and what should trigger escalation.
Closed-loop workflow
From preparation to documented follow-through
Prepare
Review the current record, reconcile important changes, and decide what the receiver needs to know or decide.
Connect
Identify yourself, verify the patient and receiver, and state the urgency and purpose at the beginning.
Structure
Use the organization’s standard framework. Prioritize the current problem, safety, uncertainty, and needed action.
Confirm
Invite questions and use check-back or repeat-back for critical information, tasks, deadlines, and contingency plans.
Document
Record who was contacted, what was communicated, recommendations received, decisions made, and pending follow-up.
Focused consultation
Ask a question the consultant can answer
What do I need from the consultant?
Clarification of diagnosis, medication guidance, procedural evaluation, interpretation of findings, disposition help, or transfer of care?
Why is consultation needed now?
State the clinical change, unanswered question, failed step, safety concern, or limit of current scope or resources.
What has already been assessed or tried?
Summarize the relevant workup, treatment, response, collateral, and barriers so effort is not duplicated.
What decision depends on the response?
Make the consequence visible: continue outpatient care, change treatment, obtain testing, escalate, transfer, or arrange follow-up.
Quality check
Common communication failures—and the correction
Data dump
A long chronology obscures the current problem. Lead with the situation and include only background that changes interpretation or action.
Diagnosis without evidence
Share the findings and uncertainty behind the working impression; do not transmit unsupported certainty.
Safety buried or omitted
State acute risk, protective factors, access to means, observation needs, and level-of-care concerns early.
Vague request
Replace “please evaluate” with the specific clinical question or action needed and its urgency.
Unassigned follow-up
Identify who will order, call, reassess, notify, prescribe, document, and confirm completion—and by when.
One-way transmission
A sent message is not necessarily a completed handoff. Confirm receipt and allow discussion when responsibility changes.
Authoritative resources
Structured communication and patient safety
Handoff
Official guidance on transferring information, authority, and responsibility, including uncertainty, recent changes, the plan, and contingencies.
Open resourceSBAR
A structured framework for concise Situation, Background, Assessment, and Recommendation or Request communication.
Open resourceI-PASS
An evidence-based option for structured transitions that includes illness severity, summary, action list, situational awareness, and synthesis.
Open resourceInadequate Hand-off Communication
Patient-safety guidance for senders, receivers, organizations, standardization, discussion, and the transfer of responsibility.
Open resource