Paeds · clinical-assessment-and-reasoning
Handover, referral and consultation in paediatrics
Also known as Paediatric handover · I-PASS handoff · ISBAR referral · Clinical consultation paediatrics · Interhospital transfer communication
A fellowship approach to paediatric handover, specialty consultation, written and verbal referral, closed-loop communication and transfer of clinical information using I-PASS and ISBAR from neonate to transition.
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Target exams
Red flags
- Handover that omits illness severity, contingency plan or pending-result owner
- Sender monologue with no receiver synthesis or questions
- Consultation request without a clear question, urgency or callback path
- Language discordance without a professional interpreter
- Caregiver concern that the child is not themselves left out of the handoff
- Verbal and written handoffs that disagree
- Transfer delayed by paperwork while the child remains unstable
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Current 2026 PREP curriculum — Learning Objective 2.4.5: Manage transfer of an unwell newborn, infant, child or young person
- Renewed curriculum for first-year trainees from 2027 — Learning goal 7: Patient safety / systems
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 14: Regional, rural, and remote paediatric care
- Renewed curriculum for first-year trainees from 2027 — Learning goal 17: Acute care
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 2. Professional skills and knowledge: Communication
- 4. Professional skills and knowledge: Patient management
- 7. Patient safety, including safe prescribing
- Leadership and team working
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- Video
- General Pediatrics Content Outline — Domain 24: Patient Safety, Quality Improvement, and Research Methods
- General Pediatrics EPA 8: Executing Clinical Handovers Within or Across Settings
- General Pediatrics EPA 10: Leading Interprofessional Teams to Provide Collaborative, Family-Centered Care
- Systems-Based Practice 1: Patient Safety
- Systems-Based Practice 4: System Navigation for Patient-Centered Care – Transitions in Care
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Interpersonal and Communication Skills 2: Interprofessional and Team Communication
- Interpersonal and Communication Skills 3: Communication within Health Care Systems
- Pediatrics: Foundations EPA #8 — Communicating assessment findings and management plans to patients and/or families
- Pediatrics: Foundations EPA #10 — Transferring clinical information between health care providers during handover
- Pediatrics: Core EPA #11 — Coordinating transitions of care
Overview & Definition
You are about to leave the ward. Another doctor must keep this child safe with only the story you pass across. That story is the handover (also called handoff). It is not a polite summary. It is a safety procedure. [1] [7]
A referral asks another service to take ongoing responsibility or to see the child for a defined problem. A consultation asks for advice or a specific action while you usually keep overall care. A closed-loop exchange means the receiver restates the critical content and the sender confirms it. Read-back is the short form of that loop for orders and numbers. [17] [20]
Picture a 14-month-old with bronchiolitis who looks quieter after high-flow oxygen. If you only say “stable on the ward,” the night team may miss that effort is falling. If you say the illness severity, the if-then plan and who owns the next blood gas, they can act before collapse. That is why structure matters. [1] [12]
What good communication does
- 1
Preserve severity
State how sick the child is now and the direction of travel.
- 2
Preserve actions
Name what must be done, by whom, and by when.
- 3
Preserve contingencies
Say what you fear next and what to do if it happens.
- 4
Confirm understanding
Require receiver synthesis, not a silent nod.
- 5
Match the record
Make verbal and written handoffs agree.
References22ShowHide
- [1]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
- [2]Starmer AJ Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study. Journal of hospital medicine, 2023.PMID 36326255
- [3]Khan A Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study. BMJ (Clinical research ed.), 2018.PMID 30518517
- [4]Starmer AJ Effects of the I-PASS Nursing Handoff Bundle on communication quality and workflow. BMJ quality & safety, 2017.PMID 28679836
- [5]Huth K Implementing receiver-driven handoffs to the emergency department to reduce miscommunication. BMJ quality & safety, 2021.PMID 32299957
- [6]Jorro-Barón F Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial. BMJ quality & safety, 2021.PMID 33893213
- [7]Alcalá Minagorre PJ Safe handoff practices and improvement of communication in different paediatric settings. Anales de pediatria, 2023.PMID 37640658
- [8]Yanni E Implementation of ED I-PASS as a Standardized Handoff Tool in the Pediatric Emergency Department. Journal for healthcare quality : official publication of the National Association for Healthcare Quality, 2023.PMID 37141571
- [9]Norman KM Implementing IPASS Handoff to Improve Patient Safety in Pediatric Critical Care Transport. Air medical journal, 2023.PMID 36958881
- [10]Shahid S Evaluation of a Modified SBAR Report to Physician Tool to Standardize Communication on Neonatal Transport. American journal of perinatology, 2022.PMID 32819017
- [11]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
- [12]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
- [13]Chaichotjinda K Assessment of interhospital transport care for pediatric patients. Clinical and experimental pediatrics, 2020.PMID 31477679
- [14]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
- [15]Huth K Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity. Journal of patient safety, 2023.PMID 37729645
- [16]Pelpola JS Disparities During Family-Centered Rounds for Families Using Languages Other Than English. Pediatrics, 2025.PMID 40716767
- [17]Lauridsen KG Standardising communication to improve in-hospital cardiopulmonary resuscitation. Resuscitation, 2020.PMID 31891790
- [18]Simmons P Characterization of Communication-Related Safety Events in a Pediatric Quaternary Care Hospital. Journal of patient safety, 2026.PMID 42008794
- [19]Rosenbluth G Variation in printed handoff documents: Results and recommendations from a multicenter needs assessment. Journal of hospital medicine, 2015.PMID 26014471
- [20]Finnigan MA ISBAR for clear communication: one hospital's experience spreading the message. Australian health review : a publication of the Australian Hospital Association, 2010.PMID 21108899
- [21]Marshall SD Telephone referral education, and evidence of retention and transfer after six-months. BMC medical education, 2012.PMID 22676409
- [22]Burvenich R Towards an international consensus on safety netting advice for acutely ill children presenting to ambulatory care: a modified e-Delphi procedure. Archives of disease in childhood, 2024.PMID 38123917