ICU Transfer Note (Internal Medicine)

ICU Transfer Note

(For high-stakes safety items—code status, allergies, respiratory support, and vasoactive infusions—if unknown, document "Unknown/not yet confirmed" and add a corresponding action item. Include timestamps for vitals, labs, and key clinical events. Omit system subsections that are not clinically relevant.)

Date/Time of Note: [Date and time of documentation]

Date/Time of Transfer: [Planned or actual transfer date and time]

Transfer Direction: [Upgrade to ICU / Downgrade from ICU]

From: [Sending unit name] To: [Receiving unit name]

Primary Service: [Service name]

Receiving Team/Clinician: [Name and service / Not yet assigned]

Patient Name: [Full name] MRN: [Medical record number] Age/Sex: [Age/Sex]

Allergies: [Allergy list with reactions / NKDA / Not yet verified]

Transfer Summary

Illness Severity: [Stable / Watcher / Unstable] — [Brief justification]

[One-line patient summary: age/sex, key comorbidities, admitting diagnosis, current critical issue driving transfer]

Immediate Reason for Transfer: [For upgrades: clinical trigger(s) and ICU capability required. For downgrades: why ICU-level care is no longer required.]

Event Timeline

(Chronological key events leading to transfer with timestamps. Do not include full hospitalization narrative.)

• [Time — Event or clinical change]
• [Time — Event or clinical change]
• [Time — Event or clinical change]

Working Diagnosis

[Primary working diagnosis driving transfer] (If diagnostic uncertainty materially affects management, briefly state what is known versus unknown and what pending data will clarify.)

Course Summary

[If upgrade to ICU: Brief hospital course including admission diagnosis, key treatments, major complications, relevant consult recommendations.]

[If downgrade from ICU: ICU course including reason for admission, key interventions and response, current stability, what remains unresolved.]

Current Status at Transfer

Vital Signs ([time]): HR [value], BP [value] (MAP [value]), RR [value], SpO2 [value]% on [device], Temp [value]

Monitoring Level: [ICU continuous / Step-down / Telemetry / Floor]

Airway/Breathing: [Oxygen device and settings; work of breathing; if mechanically ventilated: mode/settings and most recent ABG with time] (Include if clinically relevant.)

Circulation: [Hemodynamic status; vasoactive agents with current doses; rhythm issues; bedside echo findings if obtained] (Include if clinically relevant.)

Neuro: [Mental status; sedation/analgesia infusions and targets; delirium status] (Include if clinically relevant.)

Renal/Fluid: [Urine output trend, net fluid balance, dialysis status if applicable] (Include if clinically relevant.)

Infectious: [Suspected/confirmed source; cultures pending with collection times; isolation status] (Include if clinically relevant.)

Key Decision-Driving Data: [Critical labs and imaging pertinent to transfer with timestamps]

Active Problems: Assessment & Plan

(List problems ordered by urgency/severity. Omit fully resolved problems unless relevant to handoff safety.)

[Problem 1 — Working diagnosis]

Status/Trend: [Summary with key data and trajectory]

• Actions Taken: [Critical interventions performed]
• Plan (next 6–24h): [Explicit orders, targets, weaning/escalation steps]
• Monitoring & Contingencies: [What to monitor and thresholds that trigger action]
• Owner: [Team/service managing this problem]

[Problem 2 — Working diagnosis]

(Repeat structure for additional active problems.)

Active Medications & Infusions

(List high-risk and immediately relevant therapies only. If medication reconciliation is incomplete, document explicitly.)

• Antibiotics: [Agent(s), indication, start date, planned duration]
• Anticoagulation: [Agent, dose, last dose time, hold parameters]
• Insulin: [Regimen, target, last glucose with time]
• Steroids: [Agent, dose, taper plan if any]
• Sedation/Analgesia: [Agent(s), current rate(s), target]
• Vasoactive Agents: [Agent(s), current rate(s), titration goal, hold parameters]
• Significant Changes at Transfer: [Started/stopped/adjusted items]
• Medication Reconciliation: [Complete / Incomplete — actions pending]

Lines, Tubes, and Devices

(List all invasive lines, tubes, drains, and devices with location, date placed, and plan.)

• [Device type and location — placed date — Plan: continue/remove/replace]
• [Device type and location — placed date — Plan]

Pending Items & Action List

(Discrete, checkable tasks with timing and responsible party.)

• [Task — Due time — Responsible party]
• [Labs/studies to follow up — Expected time — Responsible]
• [Consults pending — Purpose — Responsible]
• [Family communication needs — Responsible]

Contingency Plans

(Explicit if-then guidance for likely near-term clinical changes.)

• [If condition/threshold, then action and who to contact]
• [If condition/threshold, then action and who to contact]

Goals of Care

Code Status: [Status] ([Confirmed date/time / Not yet confirmed])

Decision-Maker: [Name, relationship, contact / Unknown — add to Pending Items]

Goals Discussion: [Summary of discussion, with whom, when]

Capacity: [Has decision-making capacity / Lacks capacity — basis]

Handoff Communication

Receiving Clinician: [Name and service]

Verbal Handoff: [Date/time] (Document that questions were invited and addressed.)

Transport Requirements: [Monitoring, isolation precautions, critical equipment/infusions]

Responsibility Transfer: [Time care responsibility transfers per institutional practice]