I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration

Shah, Chirayu; Sanber, Khaled; Jacobson, Rachael; Kaul, Bhavika; Tuthill, Sarah; Hemmige, Vagish; Guy, Elizabeth; Greenberg, S D

doi:10.4300/jgme-d-19-00755.1

Cited by 4 publications

(1 citation statement)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several tools, such as the ISBAR (Introduction, Situation, Background, Assessment, Recommendation) and I-PASS (Illness severity, Patient information, Action list, Situational awareness and contingency plans, and Synthesis) exist to aid in organising communication during handovers 10 11. However, evidence of reliability and validity is limited, and many studies were conducted in simulated, not clinical, settings 12 13. Moreover, the development of these tools was not informed by theory.…”

Section: Introductionmentioning

confidence: 99%

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

Altabbaa,

Beran,

Clark

et al. 2024

BMJ Open Qual

View full text Add to dashboard Cite

BackgroundExisting handover communication tools often lack a clear theoretical foundation, have limited psychometric evidence, and overlook effective communication strategies for enhancing diagnostic reasoning. This oversight becomes critical as communication breakdowns during handovers have been implicated in poor patient care. To address these issues, we developed a structured communication tool: Background, Responsible diagnosis, Included differential diagnosis, Excluded differential diagnosis, Follow-up, and Communication (BRIEF-C). It is informed by cognitive bias theory, shows evidence of reliability and validity of its scores, and includes strategies for actively sending and receiving information in medical handovers.DesignA pre–test post-test intervention study.SettingInpatient internal medicine and orthopaedic surgery units at one tertiary care hospital.InterventionThe BRIEF-C tool was presented to internal medicine and orthopaedic surgery faculty and residents who participated in an in-person educational session, followed by a 2-week period where they practised using it with feedback.MeasurementsClinical handovers were audiorecorded over 1 week for the pre- and again for the post-periods, then transcribed for analysis. Two faculty raters from internal medicine and orthopaedic surgery scored the transcripts of handovers using the BRIEF-C framework. The two raters were blinded to the time periods.ResultsA principal component analysis identified two subscales on the BRIEF-C: diagnostic clinical reasoning and communication, with high interitem consistency (Cronbach’s alpha of 0.82 and 0.99, respectively). One sample t-test indicated significant improvement in diagnostic clinical reasoning (pre-test: M=0.97, SD=0.50; post-test: M=1.31, SD=0.64; t(64)=4.26, p<0.05, medium to large Cohen’s d=0.63) and communication (pre-test: M=0.02, SD=0.16; post-test: M=0.48, SD=0.83); t(64)=4.52, p<0.05, large Cohen’s d=0.83).ConclusionThis study demonstrates evidence supporting the reliability and validity of scores on the BRIEF-C as good indicators of diagnostic clinical reasoning and communication shared during handovers.

show abstract

Section: Introductionmentioning

confidence: 99%

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

Altabbaa,

Beran,

Clark

et al. 2024

BMJ Open Qual

View full text Add to dashboard Cite

show abstract

Teamwork and safety climate in Polish long-term care facilities: questionnaire reliability and usability

Świtalski,

Radomska,

Tatara

et al. 2023

Sci Rep

View full text Add to dashboard Cite

The Teamwork and Safety Climate Survey (TSCS) is one of the questionnaires used to measure patient safety. The questionnaire includes two scales: teamwork climate and safety climate. The objective of the study is the linguistic and cultural adaptation of the TSCS to Polish conditions and checking the reliability and usability of the tool in long-term care facilities. Firstly, the TSCS was translated into Polish. Then, a cross-sectional survey was conducted among the medical and auxiliary personnel of long-term care facilities all over Poland. The psychometric properties of the questionnaire were analysed (including Cronbach’s alpha coefficient). Correlations between the areas of the questionnaire and individual variables relating to facility parameters were also calculated. Respondents (n = 558) working in 26 different long-term care facilities participated in the study. The analysis has provided four scales instead of two of the original version of the questionnaire (teamwork climate, safety climate, ability to speak up and following the rules, work organisation). Correlation analysis revealed a number of significant correlations between the scales and individual variables corresponding to the parameters of long-term care facilities and respondents themselves. In conclusion, the Polish version of the TSCS may be a useful tool to measure aspects related to patient safety culture in long-term care facilities.

show abstract

Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic

Huber,

Moyano,

Blondon

2024

BMC Med Educ

View full text Add to dashboard Cite

Background Miscommunications account for up to 80% of preventable medical errors. Mnemonics like I-PASS (Illness severity, Patient summary, Actions list, Situation awareness, Synthesis) have demonstrated a positive impact on reducing error rates. Currently, physicians at our hospital do not follow a specific structure during hand-offs. We aimed to compare current hand-offs without prior training to a gold standard and the I-PASS tool in terms of content and sequence. Methods This study is a secondary analysis of data collected during a simulation study of a Friday evening hand-off to the night resident at University Hospitals of Geneva. Thirty physicians received a hand-off of four patients and managed two other patients through nursing pages at the start of the night shift, generating six sign-outs each, totaling 177 sign-outs. A focus group of three senior doctors defined the gold standard (GS) by consensus on the essential content of each sign-out. The analysis focused on the rates of relevance (ratio of information considered relevant by the GS) and completeness (proportion of transmitted elements out of all expected elements of the GS), and the distribution and sequence of the first four I-PASS categories. Results Relevance and completeness rates were 37.2% ± 0.07 and 51.9% ± 0.1, respectively, with no significant difference between residents and supervisors. There was a positive correlation between total hand-off time and relevance (residents: R2 = 0.62; supervisors: R2 = 0.67) and completeness (residents: R2 = 0.32; supervisors: R2 = 0.56). The distribution of I-PASS categories was highly skewed in both the GS (I = 2%, P = 72%, A = 17%, S = 9%) and participants (I = 6%, P = 73%, A = 14%, S = 7%), with significant differences in categories A (p = 0.046) and I (p ≤ 0.001). Sequences of I-PASS categories generally followed a P-A-S-I pattern. The first S category was frequently absent, and only one participant began by announcing the case severity as suggested by I-PASS. Conclusion We identified gaps between current medical sign-outs in our institution's general internal medicine division and the I-PASS structure. We recommend implementing the I-PASS mnemonic, emphasizing the "I" category at the start and the "S" category to anticipate and prevent complications. Future studies should assess the impact of this recommendation, adapt the mnemonic elements to the context, and introduce specific hand-off training for senior medical students.

show abstract

I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration

Cited by 4 publications

References 17 publications

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

Teamwork and safety climate in Polish long-term care facilities: questionnaire reliability and usability

Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic

Contact Info

Product

Resources

About