Implementation of the I‐PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study

Abstract

Background: Handoff miscommunications are a leading source of medical errors.Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed.Objective: To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. Design: Prospective Type 2 Hybrid effectiveness implementation study. Settings and Participants: Residents from diverse specialties across 32 hospitals (12 community, 20 academic). Intervention: External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. Main Outcome and Measures: Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality.Results: 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p < .05) and 17.5 to 9.3 minor events/person-year (p < .001).Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p < .001, n = 4812) and written (10% vs. 74%, p < .001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p < .001) and written (29% vs. 78%, p < .001) patient summaries, verbal (29% vs. 78%, p < .001) and written (24% vs. 73%, p < .001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p < .001).Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).

A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study

“…27–29 However, these process improvements have been at best surrogates for improved patient care, and recent reviews and a national consensus panel found no direct such evidence and encouraged an emphasis on finding it as a top priority. 30–32 Recently, implementation of the “I-PASS” structured handover tool in medical and pediatric hospitalist services (accompanied by extensive education and training of personnel) was associated with a reduction of self-reported “handoff-related adverse events.” 33 Our data suggest that in the setting of a high frequency of anesthesia handovers, use of a structured tool may reduce the risk of the change of personnel.…”

Implementation of a standardised accept note to improve communication during inter-hospital transfer: a prospective cohort study

“…Recall bias was likely also limited as surveys were sent to admitting clinicians within 72 hours after IHT patient admission. Additionally, prior data suggest high correlation between clinician-reported medical error rates and those captured by other more resource-intensive methodologies (eg, targeted medical record review), 24 29 and the improvement seen in clinician-reported events was accompanied by similar improvements in more objective patient outcomes. Another potential limitation is confounding due to differences in patient populations during the two study periods, as noted in table 1 .…”

Goals of care and end-of-life communication needs of persons with chronic respiratory disease

“…Although evidence-based tools for hospice handoffs do not exist [34], lessons learned from tools in other settings among patients with serious illness may be of value to adapt a structured handoff process for hospice transitions. The five quality patient handoff components from the evidence-based I-PASS handoff project include the following topics: illness severity (I), patient summary (P), action list (A), situational awareness and contingency plans (S), and synthesis by the receiver (S) [35]. A critical component of the handoff process should include a discharge checklist with components such as lists of medications and medical equipment, as well as names of clinicians and caregivers.…”