Over 6000 doctors, nurses, and therapists have been trained on the I-PASS patient handoff method to improve handover quality, and reduce preventable errors and adverse outcomes.
Massachusetts General project completed phase 1 of I-PASS implementation from 2013 to 2016, and currently in phase 2.
Excerpt: “Healthcare has become increasingly complex and care delivery models have changed dramatically (eg, team-based care, duty-hour restrictions). However, approaches to critical communications among providers have not evolved to meet these new challenges. Evidence from safety culture surveys, academic studies and malpractice claims suggests that healthcare handover quality is problematic, leading to preventable errors and adverse outcomes.”
“To address this concern, from 2013 to 2016 Massachusetts General Hospital completed phase I of a multifaceted programme to implement standardised, structured handovers across all departments, units and direct care providers.”
“A multidisciplinary Handovers Committee selected the [Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver (I-PASS)] handover system. Phase I implementation focused on large-scale training and shift-to-shift handovers. Important features included administrative and clinical leadership support; EHR templates for I-PASS; hospital handover policy revision; varied educational modalities, venues and durations; concomitant TeamSTEPPS training; unit-level IPASS champions; handover observations; and solicitation of caregiver feedback and suggestions.”
“Results: More than 6000 doctors, nurses and therapists have been trained. Trended observation scores demonstrate progressive but non-uniform adoption of I-PASS, with significant improvements in the correct sequencing and percentage of I-PASS elements included in handovers. Adoption of Synthesis (readback) has been challenging, with lower scores.”
“Conclusions: Comprehensive I-PASS implementation in a large academic medical centre necessitated major cultural change. I-PASS education is straightforward, whereas assuring consistent and sustained adoption across all services is more challenging, requiring adaptation of the basic I-PASS structure to local needs and workflows. EHR I-PASS templates facilitated caregiver acceptance. Initial phase I results are encouraging and the lessons learned should be helpful to other programmes planning handover initiatives. Phase II is ongoing, focusing on more uniform and consistent adoption, spread and sustainability.”
Source: British Medical Journal
WBB Take: Patient handoff and discharge are two of the most risky events in the patient journey through the care process, and account for the lion’s share of mistakes and missed opportunities. Incomplete or incorrect information transfer, (or failure to transfer at all) can result in sub-optimal patient outcomes, injury, or death. Standardizing the patient handoff process and making it a “no interruption” activity can reduce risks due to distraction, multitasking, and missed steps, while also reducing missed opportunities. Quality Improvement approaches can greatly increase adoption and effectiveness of standardized handoff processes by identifying what works and observing what doesn’t work, and intervening in an effective and timely fashion to refine the handoff process and remove obstacles to adoption and compliance.