Context brief: clinical handover

C:\> type demos\clinical-handover-demo.json

{
  "raw_materials": {
    "key_facts": [
      {
        "label": "Patient",
        "value": "M. Ihenacho, Bay 4"
      },
      {
        "label": "Post-op day",
        "value": "1"
      },
      {
        "label": "Falls this admission",
        "value": "1"
      },
      {
        "label": "Open family request",
        "value": "1"
      }
    ],
    "shift_notes": [
      {
        "from": "Ward round, Dr. Whitfield",
        "when": "08:40",
        "body": "Post-op day 1 following bowel resection. Anticoagulation (enoxaparin) held pre-op, plan to restart this evening once haemostasis confirmed, check before administering. Diet: sips only until physio review. Wound dressing dry and intact."
      },
      {
        "from": "Physio, C. Osei",
        "when": "11:15",
        "body": "Attempted first mobilisation today. Patient became dizzy and unsteady after two steps, sat down abruptly in the chair, no injury but logged as a fall per ward policy. Recommend standby assistance only for next attempt, not independent mobilising."
      },
      {
        "from": "Staff nurse, morning, R. Bekele",
        "when": "13:30",
        "body": "Family (daughter, Grace) visited, asked about discharge planning and seemed worried about how mum will manage stairs at home. Said she'd like to speak to someone before any discharge decision is made. Also asked about parking validation, directed to reception."
      },
      {
        "from": "Staff nurse, afternoon, R. Bekele",
        "when": "16:00",
        "body": "Sips upgraded to light diet after physio review, tolerated well. Enoxaparin not yet restarted, awaiting evening round confirmation. Pain well controlled on current regimen. Bay 4 side room fan not working, maintenance logged."
      }
    ],
    "care_plan_excerpt": [
      "Any inpatient fall during the current admission must be flagged on every subsequent handover until discharge, regardless of whether an injury occurred.",
      "Anticoagulation held pre-operatively must be explicitly confirmed as restarted, or flagged as still held with the reason, at every handover until confirmed restarted.",
      "A family request to speak with a clinician before a decision (e.g. discharge) must be handed over as an open action, not treated as resolved once logged."
    ],
    "handover_standard": {
      "do": [
        "Lead with anything that changes what the incoming team needs to check or do differently",
        "State current status, not just what happened earlier in the shift",
        "Name open actions explicitly, including who they're waiting on"
      ],
      "dont": [
        "Don't bury a safety flag under routine updates",
        "Don't assume the incoming nurse has read the full notes",
        "Don't mark something as done when it's only been requested"
      ]
    }
  },
  "presets": [
    {
      "id": "none",
      "label": "No curation",
      "summary": "The raw shift notes, care plan excerpt and handover standard, handed over as-is with no framing.",
      "brief": "No brief. The model was given the full shift notes, the care plan excerpt and the handover standard, unedited, with the instruction \"write the handover summary for the incoming nurse.\"",
      "response": "Handover for M. Ihenacho, Bay 4. Post-op day 1 following bowel resection. This morning the doctor reviewed and said anticoagulation was held pre-op and can restart once haemostasis is confirmed. Diet was sips only, then physio saw her at 11:15, and diet was upgraded to light diet in the afternoon which she tolerated well. Family visited and asked about discharge and parking, was directed to reception for parking validation. Pain is well controlled. The bay 4 side room fan isn't working and maintenance has been logged. Wound dressing dry and intact.",
      "critique": "Drops the fall entirely, the physio session is mentioned only as a diet-review checkpoint. Repeats the morning's anticoagulation plan without updating it, so it reads as already resolved. Conflates the family's request to speak to someone before any discharge decision with the unrelated parking question. Gives a broken fan the same narrative weight as a missed anticoagulation restart.",
      "annotations": [
        {
          "id": "n1",
          "type": "gap",
          "label": "The physio note logs a fall during this session. The summary drops it entirely and mentions the session only as a diet-review checkpoint.",
          "response_span": "physio saw her at 11:15"
        },
        {
          "id": "n2",
          "type": "gap",
          "label": "This is the 08:40 plan. The 16:00 note says it's still not restarted, awaiting confirmation, but the summary never updates it.",
          "response_span": "anticoagulation was held pre-op and can restart once haemostasis is confirmed"
        },
        {
          "id": "n3",
          "type": "gap",
          "label": "Reads as if the discharge conversation request was resolved by directing her to reception, when reception was only for parking. The request to speak to someone before any discharge decision is left open in the source notes.",
          "response_span": "Family visited and asked about discharge and parking, was directed to reception for parking validation."
        },
        {
          "id": "n4",
          "type": "gap",
          "label": "A broken fan gets the same narrative weight as a missed anticoagulation restart and an unflagged fall.",
          "response_span": "The bay 4 side room fan isn't working and maintenance has been logged."
        }
      ]
    },
    {
      "id": "partial",
      "label": "Partial curation",
      "summary": "The two clinical safety flags are handed over correctly, but the family's open request disappears.",
      "brief": "Situation: M. Ihenacho, Bay 4, post-op day 1. Flag for incoming nurse: patient fell during physio mobilisation today (no injury), standby assistance only for next attempt. Anticoagulation (enoxaparin) held pre-op, not yet restarted as of 16:00, awaiting evening round confirmation, check before administering.",
      "response": "Handover for M. Ihenacho, Bay 4, post-op day 1. Flagging: patient had a fall during physio mobilisation this morning, no injury, but she needs standby assistance only for the next attempt, not independent mobilising. Anticoagulation (enoxaparin) has been held since pre-op and has not yet been restarted as of this afternoon; check with the evening round before administering. Diet has progressed to light diet, tolerated well. Wound dressing dry and intact.",
      "critique": "Both safety flags are correct and current, real progress over the unfiltered version. But the brief said nothing about the family's request to speak to someone before any discharge decision, so it's dropped from the handover entirely, even though the care plan requires an open family request to be handed over as an open action.",
      "annotations": [
        {
          "id": "p1",
          "type": "pair",
          "brief_line": "patient fell during physio mobilisation today (no injury), standby assistance only for next attempt",
          "response_span": "patient had a fall during physio mobilisation this morning, no injury, but she needs standby assistance only for the next attempt, not independent mobilising."
        },
        {
          "id": "p2",
          "type": "pair",
          "brief_line": "not yet restarted as of 16:00, awaiting evening round confirmation, check before administering",
          "response_span": "has not yet been restarted as of this afternoon; check with the evening round before administering."
        },
        {
          "id": "p3",
          "type": "gap",
          "label": "The brief says nothing about the family's request to speak to someone before any discharge decision, so the response moves straight from the safety flags to routine diet updates without it.",
          "response_span": "Diet has progressed to light diet, tolerated well."
        }
      ]
    },
    {
      "id": "full",
      "label": "Full curation",
      "summary": "All three open actions are named, current status replaces stale morning status, and routine items are demoted rather than dropped.",
      "brief": "Situation: M. Ihenacho, Bay 4, post-op day 1 following bowel resection. What's changed and needs action: (1) Patient fell during physio mobilisation today, no injury, but is now standby-assistance-only for mobilising, not independent, until physio reviews again. (2) Anticoagulation (enoxaparin) has been held since pre-op and is still not restarted as of 16:00; confirm with the evening round before administering, don't assume this morning's plan to restart this evening has happened. (3) Daughter Grace has asked to speak to a clinician before any discharge decision is made; this is still open, waiting on someone to call her back, not resolved by directing her to reception (that was only about parking). Not urgent: diet has progressed to light diet and is tolerated well; wound dressing dry and intact; pain well controlled. Not clinical, don't lead with it: side room fan fault has been logged with maintenance.",
      "response": "Handover for M. Ihenacho, Bay 4, post-op day 1. Three things need action from you. First, she fell during physio mobilisation today, no injury, but she's standby-assistance-only for mobilising now, not independent, until physio reviews again. Second, enoxaparin has been held since pre-op and is still not restarted as of this afternoon; check with the evening round rather than assuming this morning's plan already happened. Third, her daughter Grace has asked to speak to a clinician before any discharge decision, that's still open and waiting on a callback, not resolved by the parking conversation. Everything else is routine: diet's progressed to light diet and she's tolerating it, wound dressing's dry and intact, pain's well controlled. One non-clinical note, the side room fan fault is logged with maintenance.",
      "critique": "Leads with the three things that change what the incoming nurse needs to check or do, states current status rather than repeating the morning's plan, and names the family's request as an explicit open action rather than letting it get folded into the unrelated parking conversation. Routine updates and the fan fault are present but demoted, not buried and not dropped.",
      "annotations": [
        {
          "id": "f1",
          "type": "pair",
          "brief_line": "Patient fell during physio mobilisation today, no injury, but is now standby-assistance-only for mobilising, not independent, until physio reviews again.",
          "response_span": "she fell during physio mobilisation today, no injury, but she's standby-assistance-only for mobilising now, not independent, until physio reviews again."
        },
        {
          "id": "f2",
          "type": "pair",
          "brief_line": "is still not restarted as of 16:00; confirm with the evening round before administering, don't assume this morning's plan to restart this evening has happened",
          "response_span": "is still not restarted as of this afternoon; check with the evening round rather than assuming this morning's plan already happened."
        },
        {
          "id": "f3",
          "type": "pair",
          "brief_line": "this is still open, waiting on someone to call her back, not resolved by directing her to reception (that was only about parking)",
          "response_span": "that's still open and waiting on a callback, not resolved by the parking conversation."
        },
        {
          "id": "f4",
          "type": "pair",
          "brief_line": "Not clinical, don't lead with it: side room fan fault has been logged with maintenance.",
          "response_span": "One non-clinical note, the side room fan fault is logged with maintenance."
        }
      ]
    }
  ]
}

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