Integrating handover curricula in medical school

Sheng, Jim; Manjunath, Sonakshi; Michael, Meghan; Gajera, Prakash; Wang, Eric; Sendelbach, Dorothy; Greilich, Philip E.; Ambardekar, Aditee

doi:10.1111/tct.13181

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Given that these two elements have proven their usefulness in improving communication between caregivers (25),( 26), (27) and are probably not yet part of the habits of the HUG internal medicine department, it could be advantageous to introduce them explicitly into the training of the internists.…”

Section: Discussionmentioning

confidence: 99%

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

Huber

Moyano

Blondon

2023

Preprint

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Background Miscommunications account for up to 80% of preventable medical errors. Mnemonics structuring these communications, such as I-PASS (Illness severity, Patient summary, Actions list, Situation awareness, Synthesis), have demonstrated a positive impact on the error rates. Currently, physicians our hospital do not follow a particular structure during their hand-offs. We sought to explore the current hand-offs without prior training compared with a gold standard, and with the I-PASS tool in terms of content and sequence. Methods We followed a secondary analysis of data collected during a simulation study of a Friday evening hand-off to the night resident. Thirty physicians received a hand-off of 4 patients and were asked to manage two other patients through nursing pages during the start of the night shift, and then generated six sign-outs for a total of 177 sign-outs in this dataset. The gold standard (GS) was defined by a focus group, who reached a consensus on the essential content of each sign-out. The analysis focused on their rate of pertinence and completeness and the exploration of the distribution of the 4 first I-PASS categories and their sequences. Results Relevance and completeness rates were 37.2%±0.07 and 51.9%±0.1, respectively, with no significant difference between residents and supervisors, and a positive correlation with total hand-off time (residents: R2=0.62 for relevance and 0.32 for completeness; supervisors: R2 =0,67 and 0.56, respectively). The distribution of I-PAS(S) categories was highly skewed in both GS (I=2%, P=72%, A=17%, S=9%) and participants (I=6%, P=73%, A=14%, S=7%), with significant differences between them for categories A (p=0.046) and I (p≤0.001). The sequences of I-PASS categories followed a general P-A-S-I pattern. The first S category was most frequently absent and only one participant began his hand-off by announcing the severity level of the case as suggested by the I-PASS tool. Conclusion Our results show that a significant number of features handed off were not considered relevant by the GS (pertinence), and that many features considered relevant were not mentioned (completeness), and inversely proportional to the duration of the hand-off. Moreover, current hand-offs differ from the I-PASS tool both in terms of content (frequent absence of categories S and I) and sequence (category I almost never at the beginning). These results highlight clear objectives for future training in medical communications.

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Section: Discussionmentioning

confidence: 99%

“…have shown (27),(28), (29) without making them longer. Future studies will be needed to assess the impact of our recommendation.…”

Section: Abbreviationsmentioning

confidence: 99%

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

Huber

Moyano

Blondon

2023

Preprint

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“…Since the completion of our prior pediatric I-PASS Study, literature has emerged suggesting that I-PASS might be adapted for use by nurses 29 and medical students, 6,30 as well as psychiatrists, 31 Emergency Department physicians, 32,33 and other provider [34][35][36] or handoff types. 37,38 While these studies reported improved outcomes and handoff quality following implementation, they typically had a less comprehensive implementation approach, reported fewer outcomes without a focus on process measures as well as adverse events and were typically conducted in only one or two units at a time within a single institution.…”

Section: Subgroup Analysesmentioning

confidence: 99%

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

Starmer

Spector

O’Toole

et al. 2022

Journal of Hospital Medicine

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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).

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“…Emphasising teaching handover skills in medical school: A recent graduate's perspective I read with interest the article by Sheng et al 1 , which highlighted the importance of teaching handover skills at medical school. As a newly…”

Section: E T T E R T O T H E E D I T O Rmentioning

confidence: 99%

Emphasising teaching handover skills in medical school: A recent graduate’s perspective

Choa

2020

The Clinical Teacher

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Integrating handover curricula in medical school

Cited by 8 publications

References 13 publications

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

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

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

Emphasising teaching handover skills in medical school: A recent graduate’s perspective

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