The fundamental aim of creating this taxonomy was to provide a universal framework to describe the clinical processes and functions essential for patient safety during handover.
I. The Three Core Processes and Their Focus
The 260 total occurrences of functions across the mnemonic elements were divided into three main processes: Clinical, Administrative, and Communication.
- Clinical Process (66.54% of all elements): This process is restricted to tasks that licensed medical practitioners operate within the scope of their licenses. The study found that two-thirds (66.54%) of all mnemonic elements focused on conveying clinical process information.
- Administrative Process (21.15% of all elements): This refers to necessary tasks that keep the hospital running but are not directly related to the treatment of a patient.
- Communication Process (12.31% of all elements): This process focuses purely on the exchange of information (verbal, written, or digital). Practitioners rated the communication process as significantly less critical in clinical handover compared to the other two processes, representing the smallest percentage of elements.
II. Deep Dive into the Clinical Process
Given its dominant presence in the mnemonics, the Clinical process includes the most frequently referenced functions.
Top Clinical Functions (by frequency):
| Function | Frequency | Definition/Example |
|---|---|---|
| Medical Condition | 15.77% (41 occurrences) | Objective description of the biological or psychological state outside the normal human range. |
| Medical History | 14.62% (38 occurrences) | A record of past events relevant to the patient’s current health. |
| Care Plan | 9.62% (25 occurrences) | The formal treatment plan delineated by the treating physician. |
| Medical Evaluation | 9.23% (24 occurrences) | Assessing the patient’s health status, including history and physical examination. |
| Outstanding Care/Tasks/Results | 8.08% (21 occurrences) | Short-term expected tasks, results, or outstanding care. |
Illustrations from Specific Mnemonics:
- SBAR, I-SBAR, ISBAR (v1/v2): These rely heavily on clinical data. The Situation element almost universally maps to the Medical condition. The Background element maps directly to Medical history.
- ASHICE: This trauma-focused mnemonic clearly emphasizes the clinical state: Injuries sustained and Condition (vitals, GCS, medications given) are classified as Medical condition.
- PEDIATRIC: This detailed mnemonic covers multiple clinical aspects, including the Problem list (Medical history), the Diagnostic one-liner (Medical diagnosis), and Therapeutics (Care plan).
- 5P (2nd version): The Problems element is classified as Medical evaluation (assessment, review of systems). The Purpose (goals to be achieved) is categorized as the Care plan.
III. Deep Dive into the Administrative Process
The Administrative process addresses the organizational necessities of patient care, contributing 21.15% of the total mnemonic elements.
Key Administrative Functions:
- Patient Information (9.62%): Information suitable for non-professional audiences, such as identity, age, sex, and location. Mnemonics like I PASS the BATON and ANTICipate use separate elements specifically for Administrative data (e.g., patient name, age, sex, MRN, room number). ICCCO‘s Identification also serves this function.
- Responsibility, Risk Prevention, and Disaster Recovery Planning (6.92%): This involves confirming shared understanding, transferring responsibility, addressing safety concerns, and contingency planning.
- For example, the 4Ps mnemonic includes Part (“What part can you play during the next shift?”) which is categorized here.
- I PASS the BATON includes Ownership (“Who is responsible?”).
- CUBAN includes Named personnel, which relates to responsibility.
- Discharge Plan (1.54%): Ensuring smooth patient transition. Mnemonics like diNAMO include Organisation (planned transfer, discharge).
IV. Deep Dive into the Communication Process
The Communication process was the least referenced area in the mnemonics (12.31%). However, the functions within this process are critical for preventing errors.
Key Communication Functions:
- Manner (6.54%): The cultural and professional codes and strategies used to achieve a communication goal.
- AIDET is highly focused on Manner, with elements like Acknowledge the patient, Introduce yourself, and Thank you.
- GRRRR is one of two mnemonics focused only on Communication, with three elements dedicated to Manner: Greeting, Respectful listening, and Reward.
- Validation (3.85%): Used to prevent errors, often through counterchecking received information (e.g., “read back”) or checking for discrepancies.
- The mnemonics I-SBAR-R, SBARR, and iSoBAR all explicitly include a “Read back” or “Response or read back” element, which is categorized as Validation.
- I-PASS includes Synthesis by receiver and Summary by receiver, both classified as Validation.
- Contextual Communication: The mnemonic Who, What, Where, When, How (4W1H), the other mnemonic focused solely on Communication, addresses the entire environment: WHO (Participants), WHAT (Culture), WHERE (Environment), WHEN (Timing), and HOW (Mode/Read back).
Summary of Implications
The analysis highlights that while mnemonics are robust in outlining the clinical data required for a handover, they are less rigorous in ensuring the accuracy and effectiveness of the information exchange itself. The minimal focus on Validation suggests that enhancing mechanisms like mandatory read back, and fostering a positive Manner to encourage clarification, are areas where clinical handover tools could be improved to strengthen interprofessional relationships and reduce errors.
The taxonomy developed in this study provides a standardized tool for practitioners to systematically analyze their own local handover needs and calibrate their tools—whether forms, EMR designs, or mnemonics—by consciously selecting elements across the three processes to achieve safer and more efficient patient handovers.
Reference: Yung, A. H. W., Pak, C. S., & Watson, B. (2023). A scoping review of clinical handover mnemonic devices. International Journal for Quality in Health Care, 35(3), mzad065.
Note: 42 clinical handover mnemonic devices and their corresponding elements:
1. 4 Ps: [P]urpose; [P]icture; [P]lan; [P]art
2. ABCDE: [A]reas and allocation; [B]eds, Bugs, Breaches; [C]olleagues, Consultant on Call; [D]eaths, Disasters, Deserters; [E]quipment, External Events
3. AIDET: [A]cknowledge the patient; [I]ntroduce yourself; [D]uration of the procedure; [E]xplanation of process and what happens next; [T]hank you for choosing our hospital (note: handoff done at bedside)
4. ANTICipate: [A]dministrative information; [N]ew clinical information, specific; [T]asks to be performed, assessment of severity of [I]llness, and [C]ontingency plans or anticipated problems
5. ASHICE: [A]ge; [S]ex; [H]istory; [I]njuries; [C]ondition; [E]xpected time of arrival
6. BAUM: [S]ituation [German: Bestand]; [A]namnesis; [E]xamination [German: Untersuchung]; [M]easures
7. CUBAN: [C]onfidential; [U]ninterrupted; [B]rief; [A]ccurate; [N]amed personnel
8. DeMIST: Patient [de]mographics; [M]echanism of injury; [I]njuries sustained; [S]ymptoms and signs; [T]reatments given
9. diNAMO: [D]octor, remember!; [I]dentity (age, sex, name); [N]eeds Of the patient (Chief complaints); [A]nalysis (State Of the evaluation); [M]edical management (planned evaluation or treatment); [O]rganization (planned transfer, discharge)
10. ED-VITALS: [E]ntity; [D]iagnosis; [V]itals; [I]nvestigations; [T]reatments; [A]ctions; [L]ogisitics; [S]ervices
11. Five-Ps (1st version): [P]atient; [P]lan; [P]urpose; [P]roblems; [P]recautions; (Physician assigned to coordinate (Captain of the ship))
12. Five-Ps (2nd version): [P]atient (identify); [P]recautions (allergies, isolation, falls, specialty bed); [P]lan of Care (fluids, intake, output, intravenous access); [P]roblems (assessment, review of systems, pain scale, etc.); [P]urpose (goals to be achieved)
13. GRRRR: [G]reeting; [R]espectful listening; [R]eview; [R]ecommend or request more information; [R]eward
14. HANDOFFS: [H]ospital Location; [A]llergies/ Adverse; [N]ame; [D]NR/Diet/ DVT prophylaxis; [O]ngoing Medical surgical problems; [F]acts about current hospitalization; [F]ollow up; [S]cenario
15. I PASS the BATON: [I]ntroduction; [P]atient details; [A]ssessment: presenting chief complaint, vitals; [S]ituation: current status; [S]afety concerns: critical laboratory results, allergies; [B]ackground; [A]ctions taken and required for later; [T]iming; [O]wnership; [N]ext
16. ICCCO: [I]dentification of the patient and clinical risks; [C]linical history/presentation; [C]linical status; [C]are plan; [O]utcomes/goals of care
17. IMIST-AMBO: [I]dentification of the patient; [M]echanism/medical complaint; [I]njuries/information relative to the complaint; [S]igns, vitals and GCS; [T]reatment and trends/response to treatment; [A]llergies; [M]edications; [B]ackground history; [O]ther (social) information (IMIST-AMBO)
18. I-PASS: [I]llness severity; [P]atient summary; [A]ction list; [S]ynthesis by receiver; [S]ummary by receiver (after all patients are presented)
19. ISBAR (v2): [I]dentity of patient; [S]ituation; [B]ackground; [A]ssessment and action; [R]esponse and rationale
20. ISBAR (v1): [I]dentification, [S]ituation, [B]ackground, [A]ssessment, [R]ecommendation
21. I-SBAR: [I]ntroduction; [S]ituation; [B]ackground; [A]ssessment; [R]ecommendation
22. I-SBAR-R: [I]ntroduce; [S]ituation; [B]ackground; [A]ssessment; [R]ecommendation; [R]ead back
23. ISOBAR: [I]dentification of patient; [S]ituation and status; [O]bservations of patient; [B]ackground and history; [A]ction, agreed plan and accountability; [R]esponsibility and risk management
24. iSoBAR: [I]dentify; [S]ituation; [O]bservations; [B]ackground; [A]greed plan; [R]ead back
25. JUMP: [J]obs outstanding; [U]nseen patients; [M]edical contacts; [P]atients to be aware of
26. Just Go NUTS: [N]ame; [U]nusual factors; [T]ubes; [S]afety concerns
27. M.I.S.T. Report: [M]echanism; [I]njuries; [S]igns/Symptoms; [T]reatment
28. PACE: [P]atient/Problem; [A]ssessment/actions; [C]ontinuing/changes; [E]valuation
29. PEDIATRIC: [P]roblem list; [E]xpected tasks to be done; [D]iagnostic one-liner; [I]f /then; [A]dministrative data/advanced directives; [T]herapeutics; [R]esults and other important facts; [I]V access/invasive devices; [C]ustody and current issues
30. P-VITAL: [P]resent; [V]ital signs; [I]nput and output; [T]reatment and diagnosis; [A]dmission or discharge; [L]egal issues
31. SBAR: [S]ituation; [B]ackground; [A]ssessment; [R]ecommendation
32. SBARR: [S]ituation; [B]ackground; [A]ssessment; [R]ecommendation; [R]esponse or read back
33. SBAR-T: [S]ituation; [B]ackground; [A]ssessment; [R]ecommendation; [T]hank patients for opportunity to work with them (note: handoff done at bedside)
34. SHARED: [S]ituation; [H]istory; [A]ssessment; [R]isk; [E]vents; [D]ocumentation
35. SHARQ: [S]ituation (describe the situation); [H]istory (past medical history, allergies, home medications); [A]ssessment (current medications, intake, output, status); [R]ecommendations (recommendations, results, discharge planning); [Q]uestions (opportunity to ask questions)
36. SIGNOUT: [S]ick or DNR; [I]dentifying data; [G]eneral hospital; [N]ew events of the day; [O]verall health status/clinical condition; [U]pcoming possibilities with plan, rationale; [T]asks to complete with plan, rationale
37. SOAP: [S]ubjective; [O]bjective; [A]ssessment; [P]lan
38. STICC: [S]ituation; [T]ask; [I]ntent; [C]oncern; [C]alibrate
39. TAG, You’re it!: [T]arget; [A]ssessment; [G]ame Plan
40. VITAL: [V]ital signs; [I]nput and output patterns; [T]reatments; [A]mbulatory abilities; Relevant [l]egal documents
41. WHO MISSED IP?: [Who] (patient ID as patient’s name, sex, age, and pre-injury health status), [M]echanism of trauma, [I]njury (suspected or sustained), [S]ign & [S]ymptom (containing observations and monitoring), [E]valuation (Imaging, laboratory, etc.), [D]iagnosis, [I]ntervention (therapy and consulting), [P]lan for patient management, and [?] giving an opportunity to question in the case of any ambiguity
42. Who, What, Where, When, How (aka. 4W1H): [WHO] should participate in the sign out process? [WHAT] content needs to be verbally communicated? [WHERE] should sign out occur? [WHEN] is the optimal time for sign out? [HOW] should verbal communication be performed?