Icu call format
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ICU call format SBAR handover template structured communication
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Here is the standard ICU Call Format used in clinical practice - a structured framework for communicating with the on-call team, escalating concerns, or handing over a patient.
ICU Call Format (SBAR-Based)
The most widely used structure is SBAR: Situation - Background - Assessment - Recommendation. In the ICU, it is often expanded to include vitals, lines, and active issues.
S - Situation
Who you are, who you're calling about, and why
- "This is [Your Name], [role] calling from [ICU/Ward/Bed number]"
- "I'm calling about [Patient Name], [Age], [Sex], in Bed [X]"
- "The problem I'm calling about is: [chief concern - e.g., acute hypotension, desaturation, altered consciousness]"
- Code status: [Full code / DNR / DNI]
B - Background
Relevant clinical context
- Admission diagnosis and date of admission
- PMH (relevant past medical history)
- Current medications, IV fluids, infusions (vasopressors, sedation, antibiotics)
- Allergies
- Procedures/lines: ETT (size, depth), central lines, arterial lines, chest tubes, drains
- Recent labs, cultures, imaging results
- Ventilator settings (if applicable): Mode, FiO2, PEEP, RR, Vt
A - Assessment
Your clinical impression
- "I think the problem is [working diagnosis]"
- Current vital signs:
- BP: /
- HR: ___
- SpO2: ___% on FiO2 ___% / ___ L/min
- RR: ___
- Temp: ___
- GCS: E___V___M___ = ___
- Relevant trends (e.g., "BP has been dropping over the last 2 hours despite 2L of fluid")
- "I am concerned about [specific worry - e.g., septic shock, ARDS, raised ICP]"
R - Recommendation
What you need / what you suggest
- "I would like you to come and review the patient"
- OR: "I need an order for [medication / investigation / procedure]"
- "I have already done / given: [interventions taken so far]"
- "Is there anything else you would like me to do while we wait?"
ICU-Specific Add-ons
In a full ICU handover call or end-of-shift handover, include:
| Category | Details |
|---|---|
| Airway | ETT size/depth, tracheostomy, self-ventilating |
| Breathing | Vent mode, FiO2, PEEP, last ABG |
| Circulation | MAP target, vasopressors, fluid balance (24h) |
| Neuro | GCS, sedation score (RASS), pain score, pupils |
| Renal | UO (per hour), creatinine, RRT if running |
| GI/Nutrition | Feeding route, rate, bowel movements |
| Haematology | Hb, platelets, anticoagulation |
| Microbiology | Active cultures, antibiotics (day X of Y) |
| Lines/Access | CVC, arterial line, IDC, nasogastric tube |
| Active issues | What is unresolved, what to watch for |
| Plan | Goals for the next shift, family update needed? |
Quick Mnemonic: ABCDE + FAST
Some ICU teams use this for rapid phone escalation:
- F - Finding (what's wrong right now)
- A - Assessment (your impression)
- S - Situation (patient background)
- T - Task (what you need done)
Example ICU Call Script
"Hi, this is Dr. Sarah, the intern on ICU. I'm calling about Mr. Ahmed, 58-year-old male, Bed 4, admitted 3 days ago with severe pneumonia and on pressure control ventilation.He's been having worsening hypoxia over the last hour. Current SpO2 is 84% on FiO2 100%, PEEP 12. BP is 90/60, HR 118, Temp 38.9. GCS is 8.I think he may be developing a pneumothorax or worsening ARDS. I've increased FiO2 and done a CXR which is pending.I need you to come and review him urgently. Should I prepare for anything else in the meantime?"
This format keeps calls concise, safe, and actionable. The key principle is: never call without knowing the vitals, the background, and what you need.
Medical fitness call
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Here is the full Medical Fitness Call Format - used when a physician/internist/ICU team is called to assess and document whether a patient is medically fit for surgery, anaesthesia, or an invasive procedure.
Medical Fitness Call Format
What It Is
A medical fitness call (also called a fitness for surgery/procedure call) is a structured consultation where:
- The requesting team (surgeon, anaesthetist) calls the medicine/ICU team
- They provide the clinical picture and the planned procedure
- The medicine team assesses the patient and gives a clearance opinion
Part 1: The Requesting Call (Surgeon → Medicine Team)
Use SBAR structure when requesting the fitness assessment:
S - Situation
- "I'm [Name, Role] from the [Surgical/Ortho/Urology] team"
- "I'm calling to request a medical fitness assessment for [Patient Name], [Age/Sex], Bed [X]"
- "We are planning to do [Procedure/Surgery] - [elective/semi-elective/urgent/emergency]"
- "Planned date: [X] / ETA to OT: X hours"
B - Background
- Admitting diagnosis
- Relevant PMH: cardiac, respiratory, renal, DM, coagulopathy
- Current medications (especially anticoagulants, antiplatelets, antihypertensives, insulin)
- Allergies
- Recent vitals and baseline observations
- Recent investigations: ECG, Echo, PFTs, labs (Hb, Cr, eGFR, coagulation)
- Functional capacity: Can the patient climb one flight of stairs? Walk on flat ground? (METs)
A - Assessment (as known)
- ASA classification if known
- Any known cardiac/respiratory/renal risk
- "The anaesthetist is concerned about [specific issue]"
R - Request
- "We need a medical clearance note for [procedure]"
- "Please advise on: [anticoagulation bridging / cardiac risk / diabetic management peri-op / etc.]"
Part 2: The Medical Fitness Assessment (Medicine/ICU Review)
After reviewing the patient, the medicine team documents and communicates back using this structure:
1. Patient Details
- Name, Age, Sex, MRN, Bed
- Referred by: [Team], Date/Time of referral
2. Procedure Planned
- Surgery/procedure name
- Urgency: Elective / Urgent / Emergency
3. History & Examination
| System | Findings |
|---|---|
| CVS | BP, HR, JVP, murmurs, signs of CCF, recent ACS, pacemaker |
| Respiratory | SpO2, air entry, wheeze, COPD/asthma control |
| Renal | UO, creatinine, eGFR, dialysis-dependent? |
| Hepatic | LFTs, coagulopathy, jaundice |
| Neuro | Baseline GCS, neurological deficits |
| Endocrine | DM control (HbA1c, glucose), thyroid status, steroids |
| Haematology | Hb, platelets, on anticoagulants? |
| Nutritional | BMI, malnutrition risk |
4. Risk Stratification
Cardiac Risk (RCRI - Revised Cardiac Risk Index)
Score 1 point for each:
- High-risk surgery
- History of ischaemic heart disease
- History of heart failure
- History of cerebrovascular disease
- Insulin-dependent diabetes
- Creatinine > 177 µmol/L (> 2.0 mg/dL)
| Score | MACE Risk |
|---|---|
| 0 | ~0.4% |
| 1 | ~1% |
| 2 | ~2.4% |
| ≥ 3 | ~5.4%+ |
Functional Capacity (METs)
- < 4 METs (cannot walk 1-2 flat blocks or climb 1 flight): poor functional capacity - higher risk
- ≥ 4 METs: acceptable functional capacity
ASA Classification
| Class | Description |
|---|---|
| I | Normal healthy patient |
| II | Mild systemic disease |
| III | Severe systemic disease |
| IV | Severe disease - constant threat to life |
| V | Moribund - not expected to survive without surgery |
| E | Emergency suffix (e.g. IIIE) |
5. Investigations Reviewed / Recommended
- ECG: [findings]
- CXR: [findings]
- Echo: [EF, valvular disease]
- FBC, UEC, LFTs, coags, Group & Screen
- HbA1c, fasting glucose (if diabetic)
- PFTs (if respiratory concern)
- Stress test / cardiology referral (if warranted)
6. Optimisation Recommendations
Common pre-op optimisations to state:
| Issue | Recommendation |
|---|---|
| Hypertension | Optimise BP, continue antihypertensives on day of surgery |
| Anticoagulation | Bridging protocol / withhold warfarin X days / check INR |
| Antiplatelet | Continue or stop aspirin (discuss with surgeon) |
| Diabetes | Sliding scale insulin, hold metformin 24-48h pre-op |
| Anaemia | Transfuse if Hb < 8 (or < 10 if cardiac) |
| Renal impairment | Hydration, avoid nephrotoxins, post-op monitoring |
| Cardiac | Cardiology review if uncontrolled HF or recent ACS |
| Steroids | Stress dosing if on chronic steroids |
7. Fitness Opinion
State clearly:
"[Patient Name] is medically FIT / NOT FIT / FIT WITH OPTIMISATION for [procedure] under [general/spinal/regional/local] anaesthesia."
Then specify:
- Anaesthetic preference: GA / spinal / regional / LA preferred (and why)
- Risk level: Low / Intermediate / High
- Special precautions: HDU/ICU post-op, avoid hypotension, renal monitoring, etc.
- Validity: "Reassess if condition changes"
8. Reviewer Details
- Name, designation, team
- Date and time of review
- Contact number for queries
Quick Reference Card
MEDICAL FITNESS CALL - QUICK FORMAT
=====================================
1. PATIENT: Name / Age / Bed
2. PROCEDURE: What & When (urgency)
3. SYSTEMS REVIEW: CVS / Resp / Renal / Neuro / Endo
4. RISK: RCRI score / METs / ASA grade
5. INVESTIGATIONS: Reviewed + Pending
6. OPTIMISE: Specific instructions per issue
7. OPINION: FIT / NOT FIT / FIT WITH OPTIMISATION
8. ANAESTHESIA: Type preferred
9. POST-OP PLAN: HDU/ICU? Special monitoring?
10. REVIEWER: Name + contact
This format ensures nothing is missed and gives the anaesthesia and surgical teams a clear, defensible medical opinion before proceeding.
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