ICU Transfer Note (ICU-to-Floor/Step-Down)

Transfer Date/Time: [Transfer date and time]

Sending ICU/Team: [Sending ICU unit and primary team]

Receiving Service/Unit: [Receiving service and level of care (floor / step-down)]

Author/Contact: [Author name, role, and direct contact number]

Transfer Snapshot

• Stability: [Stable / Watcher / Unstable]
• ICU Admission Reason: [One-phrase reason for ICU admission]
• Current Supports:
  • Airway/O2: [Device and settings, as of date/time]
  • Hemodynamics: [Pressors in last 24h yes/no; MAP goal if applicable, as of date/time]
  • Renal support: [RRT yes/no; last run date/time; access type and site if applicable]
• Key Devices:
  • Central line(s): [Type and site / None]
  • Arterial line: [Site / None]
  • Foley: [Present / None]
  • Feeding tube: [Type and site / None]
  • Chest tube(s): [Side and type / None]
  • Drains: [Type and site / None]
  • Airway device: [ETT or trach with cuff status / None]
• Active Antimicrobials: [Drug(s), indication, stop/review date / None]
• Isolation: [Precaution type and indication / None]
• Code Status: [Current code status] — [Surrogate/decision-maker name, relationship, and contact if known]
• Top Actions (next 24h):
  • [Priority task #1]
  • [Priority task #2]
  • [Priority task #3]

Patient Summary

[Age, sex, key comorbidities, admitting problem. ICU entry trigger and major interventions. Current status explaining why appropriate for floor/step-down. Diagnostic uncertainty if present.] (2–4 sentences)

ICU Course

[Brief narrative of ICU stay highlighting major interventions, procedures with dates, complications, key culture/imaging results driving ongoing plans, and notable medication transitions]

• [Date]: [Key milestone, intervention, or complication]
• [Date]: [Key milestone, intervention, or complication]
• [Date]: [Key milestone, intervention, or complication]

(Use chronologic milestones for short or eventful stays; system-based micro-summary acceptable for longer stays)

Current Status at Transfer

(Include only systems relevant to patient's ICU course and ongoing care)

• Vitals/Monitoring: [Most recent vitals with time; pertinent trends; telemetry requirement yes/no with indication]
• Neuro: [Baseline vs current mental status; delirium risk; sedation/analgesia regimen if relevant]
• Respiratory: [Oxygen device and settings with timestamp; weaning status; pulmonary toilet needs]
• Cardiovascular: [Hemodynamic stability; recent pressor timeline if applicable; arrhythmia concerns]
• Renal/Fluids: [UOP; fluid balance or diuretic plan; RRT status and next run if applicable]
• GI/Nutrition: [Diet status; aspiration risk; tube feeding details if applicable]
• Heme: [Bleeding/clot concerns; anticoagulation indication, agent, and intensity]
• Other: [Endocrine, skin/wounds, mobility] (Include only if relevant to ongoing care)

Devices

(List all device categories; state "None" explicitly if not present)

• Central line(s): [None / Present]
  • [Type, site, insertion date] — Indication: [Indication]; Removal plan: [Criteria or target date]; Care: [Dressing schedule]
• Arterial line: [None / Present]
  • [Site, insertion date] — Indication: [Indication]; Removal plan: [Criteria or target date]
• Foley: [None / Present]
  • [Insertion date] — Indication: [Indication]; Removal plan: [Criteria or target date]
• Feeding tube: [None / Present]
  • [Type, site, insertion date] — Indication: [Indication]; Removal plan: [Criteria]; Care: [Verification/flush protocol]
• Chest tube(s): [None / Present]
  • [Side, type, insertion date] — Indication: [Indication]; Removal criteria: [Air leak/output threshold]; Settings: [Suction/water seal, current output]
• Surgical drain(s): [None / Present]
  • [Type, site, insertion date] — Indication: [Indication]; Removal criteria: [Output threshold]; Care: [Strip frequency]
• Airway device: [None / Present]
  • [Device type, size, insertion date] — Cuff: [Inflated / Deflated]; Decannulation criteria: [Plan]; Care: [Suction frequency, humidification]

Antimicrobials / Infection

(If no active antimicrobials, state: "No active antimicrobials at transfer.")

• Agent: [Drug, dose/route, start date] — Indication: [Site/syndrome]
  • Microbiology: [Key positives/negatives with dates]
  • De-escalation plan: [Planned narrowing or reassessment triggers]
  • Duration: [Planned duration with explicit stop or review date]
  • Monitoring: [Levels, renal dosing adjustments, toxicity labs]

Source control: [Completed / Pending with plan and timing / N/A]

Assessment & Plan

(Organize by problem, highest acuity first)

#1. [Problem name]

Assessment: [Current status and trajectory in 1–2 lines]

• Plan:
  • [Medications with dose/route/frequency]
  • [Monitoring parameters and frequency]
  • [Consults and purpose]
  • [Labs/imaging and timing]
  • [Device plan if relevant]
• Contingency: If [trigger/threshold], then [action]; call [who to contact]

#2. [Problem name]

(Repeat structure for additional problems)

Pending / Follow-up

Pending Studies:

• [Test] — Expected: [Date/time] — Action: [What to do with results; who is responsible]

Active Consults:

• [Service] — Question: [Specific ask] — Follow-up: [When/how; who to page for questions]

Goals of Care / Code Status

• Code status: [Full Code / DNR / DNI / DNR-DNI / Comfort-focused]
• Decision-maker: [Name, relationship, contact number]
• Capacity: [Has capacity / Lacks capacity / Fluctuating] (Include if relevant)
• Last GOC discussion: [Date] — [Brief outcome]
• Escalation limits: [Specific limits or time-limited trials, e.g., no re-intubation, reassess at 72h / None specified]

Contingency Plans

• Respiratory deterioration: If [O2 threshold or work of breathing trigger], then [action]; call [RT/rapid response/ICU team and contact]
• Hemodynamic instability: If [BP/HR thresholds], then [action]; call [team and contact]
• Neurologic change: If [AMS/seizure/agitation trigger], then [action]; call [team and contact]
• Device emergency: If [trach obstruction/chest tube issue/line concern], then [immediate action]; call [team and contact]
• Patient-specific trigger: If [patient-specific concern], then [action]; call [team and contact]

Handoff

• Destination: [Floor / Step-down] — Monitoring: [Telemetry yes/no with indication] — Transport O2: [Device and flow rate]
• Special needs: [Nursing/RT requirements: suction frequency, aspiration precautions, sitter, etc.]
• Handoff completed: [Date/time] — Sender: [Name, role] — Receiver: [Name, role] — Mode: [In-person / Phone] — Questions addressed: [Yes / No]

(If handoff pending: [Planned time and responsible clinician])