Handover, records and closing the loop

Escalation is not complete until the appropriate person or route has accepted responsibility for the next step. A brief verbal note can be missed when the phone rings, the clinic falls behind, a colleague takes a break or a locum is unfamiliar with local arrangements.

Good handover is concise, factual and clearly owned. It should explain why the issue needs urgent attention, what has already occurred and who is now responsible.

A simple red-flag handover

• Who: patient name, date of birth or local identifier, and contact details.
• What: the exact symptom, concern, incident, disclosure, fault or message.
• When: when it started, when it was reported and any time-critical detail.
• Risk: why you are escalating, using factual words rather than diagnosis.
• Action: what you have already done and who you have told.
• Owner: who has accepted responsibility for the next step and how follow-up will be checked.

What to record

Note the patient's exact words where possible, your questions and their answers, the time, the route used, who took over, any advice from a registrant or urgent service, and any planned follow-up. If the concern came via a companion, online message or third party, record that clearly.

Do not record a diagnosis unless a registrant has made and recorded one. Do not alter records to conceal delays. Do not leave urgent concerns only on paper slips, private phones, memory or informal chat.

Complaints, candour and service failures

A red flag may indicate a service failure: delayed referral, missed urgent message, wrong record, data breach, equipment fault or a complaint suggesting possible harm. Support staff should escalate these through the manager, registrant, complaints, candour or data route as appropriate.

Manager controls for reliable escalation

Escalation needs an owner. If nobody has accepted the next step, the red flag has not been safely handed over.