Transfer Letter 📄
Guide for writing transfer letters for NCHDs. Structure, clinical handover content, logistics checklist, and common pitfalls for inter-hospital and specialty transfers in Irish practice.
🧠 Purpose
- A transfer letter hands over a live inpatient to another hospital, specialty, or care setting.
- It is not a discharge summary: the patient remains under active care and the receiving team needs enough detail to continue safely without re-clerking from scratch.
- Write for the accepting registrar or consultant. Be concise, chronological, and clear about what is urgent, outstanding, or uncertain.
📋 Structure
- Patient details: name, DOB, MRN, ward, consultant, next of kin and contact if relevant.
- Reason for transfer: one clear sentence (e.g. ACS for PCI, ICH for neurosurgery, ICU bed, rehab, repatriation).
- Who accepted: accepting consultant/registrar, hospital, specialty, and time of acceptance. Include bed confirmation if known.
- Presentation and working diagnoses: why they came in, primary diagnosis, and relevant secondary diagnoses.
- Hospital course: key events, treatments given, response, and complications. Keep it chronological and relevant.
- Current clinical status: observations or NEWS, conscious level, oxygen requirement, lines/devices, mobility, infection status.
- Investigations: key bloods, imaging, cultures, histology, with dates and results. Attach or list outstanding results.
- Medications: current drug chart summary, allergies, recent changes, infusions running, anticoagulation status.
- Outstanding issues: pending results, planned procedures, decisions still needed, ceilings of care / DNAR if documented.
- What you need from the receiving team: e.g. urgent CT, theatre, ICU review, take over anticoagulation.
🚑 Logistics Checklist
- Confirm accepting clinician and bed before the patient leaves, unless local emergency pathway says otherwise.
- Copy imaging and reports to travel with the patient or ensure PACS transfer / discs are arranged.
- Send recent bloods, ECG, drug chart (or printed medication list), and relevant microbiology.
- Infection control: MRSA/CPE/COVID or other alerts; isolation needs for the receiving ward.
- Escort level: nurse alone, NCHD escort, or critical care transfer team; oxygen, suction, monitoring en route.
- IV access, infusions, and pumps: what is running, rates, and when next doses are due.
- Consent and capacity: document if the patient or NOK is aware; note any objections or complex decisions.
- Update family with destination, approximate timing, and who to contact at the receiving hospital.
✍️ Sample Letter (NSTEMI for angiography)
- Dear Cardiology Team,
- Thank you for accepting the transfer of Mr John Murphy, 68-year-old man, DOB 12/03/1958, MRN 1234567, currently under Dr Byrne on Ward 4B at Regional General Hospital.
- Reason for transfer: Non-ST elevation myocardial infarction for inpatient coronary angiography.
- Accepted by Dr Siobhán Walsh (Cardiology Registrar) at University Hospital at 14:20 today. CCU bed confirmed.
- He presented yesterday with 2 hours of central chest pain radiating to the left arm, associated with nausea. Pain settled with GTN in ED. ECG showed dynamic T-wave inversion in V4–V6. High-sensitivity troponin I rose from 45 to 320 ng/L.
- Background: hypertension, type 2 diabetes, ex-smoker. No prior IHD. NKDA. Independent at baseline.
- Course so far: loaded with aspirin 300 mg and ticagrelor 180 mg; started on fondaparinux per local ACS protocol; atorvastatin 80 mg overnight; dual antiplatelets continued. Remains pain-free on the ward. No arrhythmia or heart failure clinically.
- Current status: alert, NEWS 1, HR 72, BP 128/74, SpO₂ 96% on air. One peripheral IV cannula. No oxygen requirement. MRSA screen pending. No isolation precautions.
- Key results: Hb 138, WCC 8.2, platelets 245, Na 138, K 4.1, creatinine 92, eGFR 72, glucose 9.8. CXR clear. Echo pending (not yet done here). ECG and labs travelling with the patient; PACS link arranged for ED ECG and CXR.
- Medications: aspirin 75 mg OD, ticagrelor 90 mg BD, atorvastatin 80 mg nocte, ramipril 5 mg OD, metformin 500 mg BD, fondaparinux 2.5 mg SC OD (due 08:00). No infusions running.
- Outstanding / ask: please proceed with inpatient angiography as discussed. Echo not yet performed; happy for this to be done at your end if needed. Family (wife) aware and will follow to University Hospital.
- Escort: nurse escort with portable monitor. Patient stable for transfer. Please contact me on bleep 4321 if further information needed.
- Yours sincerely, Dr Aoife Kelly, Intern, Medical Team. IMC 123456.
⚠️ Pitfalls to Avoid
- Vague reason for transfer (“for further management”) without a clear clinical question or need.
- Missing who accepted the patient, or transferring before a bed and accepting clinician are confirmed.
- Omitting allergies, anticoagulation, infection alerts, or ceiling of care.
- No current observations or clinical stability statement for the journey.
- Outstanding critical results (cultures, troponin, CT report) not flagged as pending.
- Copy-pasting an old discharge summary instead of writing a live handover.
- Leaving placeholders (“TBC”, blank drug list) in the version that travels with the patient.
🛠 Tips
- Lead with reason for transfer and current stability. Receiving teams scan the top first.
- One page is often enough for straightforward transfers; complex ICU or oncology cases may need more detail.
- Spell out acronyms once. Receiving hospitals may use different shorthand.
- If unstable, say so explicitly and confirm the escort and destination can manage that acuity.
- Phone handover plus a written letter is best practice for sick or complex patients.
- For discharge home or to the GP, use a discharge summary instead (see Discharge summary).
Note Template
Ready-to-use clinical note structure
🕒 08 / 10 / 2026 — 16:06 Transfer Letter Patient: [Name], [age] [sex], MRN [ ] From: [Ward / Hospital], under [Consultant] To: [Accepting specialty / hospital] Accepted by: [Name, role] at [date/time] Bed confirmed: [yes / no / pending] Reason for transfer: • [e.g. NSTEMI for inpatient angiography] Presentation & diagnoses: • [presenting complaint and working diagnoses] PMHx: [relevant comorbidities] Allergies: [NKDA / list] Hospital course: • [key events, treatments, response, complications] Current status: • Vitals / NEWS: [ ] • O₂ requirement: [ ] • Lines / devices: [ ] • Infection alerts / isolation: [ ] • Ceiling of care / DNAR: [if documented] Key investigations: • Bloods: [ ] • Imaging: [ ] • Outstanding results: [ ] Medications: • Current: [ ] • Infusions running: [ ] • Anticoagulation: [ ] Outstanding issues / ask of receiving team: • [pending results, planned procedures, specific clinical question] Logistics: • Escort: [nurse / NCHD / critical care] • Imaging / notes travelling with patient: [yes/no] • Family updated: [yes/no] 👤 [Your Name], [Role] IMC: _______ Contact: [bleep / phone]
Educational reference only. Medical disclaimer