![]() ![]() Its use resulted in significant decreases in reported perceived loss of patient information during intershift handoffs.Ĭopyright © 2022 National Association for Healthcare Quality. 54.2% reported a concurrent increase in written handoff documentation during the intervention.ĮD I-PASS can be successfully implemented among attending physicians in the pediatric emergency department setting. Most (76.0%) participants reported satisfaction with ED I-PASS, despite half citing a perceived increase in handoff length. 001) and the reported perceived loss of important patient information during transitions of care decreased 50%, from 75.0% to 37.5% ( p =. Use of ED I-PASS increased from 7.1% to 87.5% ( p <. Surveys regarding handoff practices were distributed before and after ED I-PASS implementation.Ĩ2.8% of participants completed follow-up surveys, and 69.6% of PEM physicians were observed performing a handoff. Data from observed handoffs were collected for process outcomes. Implementation occurred from September to April of 2021, during the height of the COVID-19 pandemic, when patient volumes were significantly lower than prepandemic levels. Our aims were to: (1) increase the proportion of physicians using ED I-PASS by two-thirds and (2) decrease the proportion reporting information loss during shift change by one-third, over a 6-month period.Īfter literature and stakeholder review, Expected Disposition, Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver (ED I-PASS) was implemented using iterative Plan-Do-Study-Act cycles, incorporating: trained "super-users" print and electronic cognitive support tools direct observation and general and targeted feedback. The purpose of this quality improvement (QI) initiative was to improve handoffs between PEM attending physicians (i.e., supervising physicians ultimately responsible for patient care) through the implementation of a modified I-PASS tool (ED I-PASS). There is a paucity of data on standardized handoff tools for intershift transitions of care in pediatric emergency medicine (PEM). A formal handoff process, such as the I-PASS handoff program, can improve communication about patients among residents. 8 The IPASS mnemonic is defined by I - illness severity, P - patient summary, A - action list, S - situational awareness and contingency planning, and S - synthesis by receiver. Balancing measures showed the residents were more satisfied with the new system and found it to be more effective at providing a safe transition of care.Ĭonclusion: Implementation of a resident-driven multidisciplinary IPASS handoff system resulted in improved inclusion of key handoff elements and increased resident satisfaction.Communication, failures during patient handoffs are a significant cause of medical error. Based on initial data, the survey results, and the gap analysis, it was determined that a pre-existing handoff tool, IPASS, best aligned with practice to address the gap. Illness severity improved from 5% to 97%, diagnosis from 60% to 100%, patient summary from 71% to 100%, contingency planning from 10% to 100%, action list from 23% to 100%, and receiver synthesis from 0% to 97%. Results: Inclusion of six key elements of handoffs improved as follows. Intervention three was development of a tool and method to decrease nurse interruptions during handoff. The second was printed cards listing appropriate handoff elements. The first was an educational series involving lecture and role playing. During this time frame, three Plan-Do-Study-Act cycles were conducted. Tracking of whether or not handoffs included the component IPASS elements was performed over an 11-month period. A survey was administered to residents regarding their opinions about the handoff process. Methods: A senior resident established a quality improvement team which developed an AIM statement (a written, measurable, and time-sensitive description of the goal of a quality improvement team) and key drivers. We chose to use the IPASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic as our standardized handoff model (2) Consider balancing measures in an effort to be aware of any negative effects of our interventions on resident satisfaction with the system. The objectives of this study were to (1) implement a resident-driven quality improvement project to improve handoffs by including key elements that are necessary for a safe and effective handoff. Background and Objectives: Previous studies have emphasized the importance of effectual communication during patient handoffs.
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