Cross-Cover Handoff Note Template

TL;DR

• When to use: Shift changes, weekend coverage, night float handoff
• What it includes: I-PASS format for safe transitions of care

Template

CROSS-COVER HANDOFF NOTE
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Patient: Room [XX]
Date: [XX/XX/XXXX]
Hospital Day #: [XX]
Primary Team: [XX] / Pager: [XXXX]

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I - ILLNESS SEVERITY
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Acuity: [ ] STABLE - Routine care, unlikely to need overnight calls
        [ ] WATCHER - May need intervention, monitor closely
        [ ] UNSTABLE - Active issues, anticipate calls/escalation

Code Status: [Full code / DNR / DNI / Comfort care]
Allergies: [NKDA or list]

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P - PATIENT SUMMARY
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ONE-LINER:
[XX]-year-old [male/female] with [key PMH] admitted [date] for [diagnosis], currently [status/trajectory].

KEY HISTORY:
- [Most relevant PMH item 1]
- [Most relevant PMH item 2]

HOSPITAL COURSE SUMMARY:
[2-3 sentences: what brought them in, key interventions, current status]

CURRENT STATUS:
- Vitals stable: [Yes/No - if no, specify]
- O2 requirement: [RA / XX L NC / other]
- Diet: [NPO / regular / restrictions]
- Activity: [bedrest / OOB to chair / ambulating]
- Lines: [PIV / central line / PICC - day XX]
- Foley: [Yes day XX / No]

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A - ACTION LIST
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OVERNIGHT TO-DOs:
[ ] [Task] - [timing/trigger] - [what to do with result]
[ ] [Task] - [timing/trigger] - [what to do with result]
[ ] [Task] - [timing/trigger] - [what to do with result]

PENDING RESULTS:
- [Test]: Expected [time], call if [XX]
- [Test]: Expected [time], call if [XX]

SCHEDULED MEDICATIONS TO MONITOR:
- [Med] at [time] - [what to watch for]

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S - SITUATION AWARENESS
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WHAT I'M WORRIED ABOUT:
- [Anticipated problem 1]
- [Anticipated problem 2]

WHAT COULD GO WRONG:
- [Potential complication/deterioration]

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S - SYNTHESIS (IF-THEN CONTINGENCIES)
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IF [scenario 1]:
THEN [action to take]

IF [scenario 2]:
THEN [action to take]

IF [scenario 3]:
THEN [action to take]

PARAMETERS TO CALL PRIMARY:
- [Vital sign threshold]
- [Lab threshold]
- [Clinical change]

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FAMILY/CONTACT INFO:
Primary contact: [relationship] - [phone]
Interpreter needed: [Yes - language / No]
Family aware of current status: [Yes / No]

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Last updated: [XX:XX] by [XX]

Why This Works

I-PASS is evidence-based: The I-PASS handoff framework reduced medical errors and preventable adverse events by 30% in studies. This is a proven safety intervention.

Illness severity upfront: Categorizing patients as STABLE/WATCHER/UNSTABLE helps cross-cover prioritize when multiple calls arrive simultaneously. This triage information saves time and focuses attention where needed.

IF-THEN contingencies are specific: Vague handoffs like “call me if anything changes” create ambiguity. Explicit contingency plans (“If K < 3.5, give 40 mEq PO and recheck in AM”) empower cross-cover to act confidently and reduce unnecessary pages.

Filled Example

[SYNTHETIC EXAMPLE - Not a real patient]

CROSS-COVER HANDOFF NOTE
========================

Patient: Room 412
Date: [XX/XX/XXXX]
Hospital Day #: 3
Primary Team: [XX] / Pager: 5432

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I - ILLNESS SEVERITY
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Acuity: [X] WATCHER - On IV heparin drip (aPTT monitoring), bridging to warfarin (INR monitoring for warfarin dosing)

Code Status: Full code
Allergies: Penicillin (rash)

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P - PATIENT SUMMARY
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ONE-LINER:
68-year-old female with COPD, AFib (not on anticoagulation) admitted 3 days ago for acute PE, currently on heparin drip bridging to warfarin, clinically stable.

KEY HISTORY:
- COPD on 2L home O2
- AFib - not anticoagulated due to prior fall risk assessment

HOSPITAL COURSE SUMMARY:
Presented with dyspnea, CTA showed segmental PE in RLL. Started heparin drip, therapeutic within 12 hours. Started warfarin 5mg day 1, INR 1.4 today. O2 requirement improved from 4L to 2L NC (her baseline). Echo showed no RV strain.

CURRENT STATUS:
- Vitals stable: Yes
- O2 requirement: 2L NC (at baseline)
- Diet: Regular
- Activity: Ambulating with assist
- Lines: PIV x 2 (right arm day 3, left hand day 1)
- Foley: No

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A - ACTION LIST
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OVERNIGHT TO-DOs:
[X] PTT at 22:00 - adjust heparin per protocol
[ ] AM labs ordered (CBC, BMP, INR, PTT)

PENDING RESULTS:
- Lower extremity dopplers: Done today, NEGATIVE for DVT
- Hypercoagulable workup: Sent, results in 3-5 days (outpatient f/u)

SCHEDULED MEDICATIONS TO MONITOR:
- Warfarin 5mg at 17:00 - already given today
- Heparin drip - continuous, PTT monitoring q6h

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S - SITUATION AWARENESS
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WHAT I'M WORRIED ABOUT:
- Supratherapeutic on heparin (PTT has been bouncing)
- Bleeding risk given age and recent start of anticoagulation

WHAT COULD GO WRONG:
- Bleeding (GI, hematuria, intracranial)
- Recurrent PE symptoms (low probability given therapeutic anticoagulation)

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S - SYNTHESIS (IF-THEN CONTINGENCIES)
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IF PTT > 120:
THEN Hold heparin x 1 hour, decrease rate by 2 units/kg/hr, recheck PTT in 6 hours

IF PTT < 60:
THEN Increase heparin by 2 units/kg/hr per protocol, recheck PTT in 6 hours

IF signs of bleeding (hematuria, melena, neuro changes):
THEN STOP heparin, check stat CBC/PTT, call primary, consider protamine if severe

IF new dyspnea or hypoxia:
THEN Check vitals, ABG, consider repeat CTA if concern for new PE vs COPD exacerbation

PARAMETERS TO CALL PRIMARY:
- SBP < 90 or MAP < 65
- Any bleeding
- Confusion or neuro changes
- Patient/family requesting update

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FAMILY/CONTACT INFO:
Primary contact: Daughter - [XXX-XXX-XXXX]
Interpreter needed: No
Family aware of current status: Yes - daughter visited today

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Last updated: 17:30 by [XX]

Checklist

• Acuity level assigned (Stable/Watcher/Unstable)
• Code status clearly documented
• One-liner captures diagnosis, trajectory, and key context
• Action items include timing and what to do with results
• Anticipatory guidance provided (what could go wrong)
• Contingency plans are specific with thresholds and actions
• Parameters for calling primary are explicit
• Family contact information included
• Timestamp and author documented

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Last reviewed: 2026-01-20. Clinical content based on society guidelines, FDA labeling, and pivotal trials available at review date. Verify against current sources before clinical use.