MENTORED IMPLEMENTATION OF THE I-PASS HANDOFF PROGRAM IN DIVERSE CLINICAL ENVIRONMENTS

Amy Starmer, MD, MPH1, Jennifer O'Toole, MD2, Nancy Spector, MD3, Daniel West, MD4, Theodore Sectish, MD5, Jeffrey Schnipper, MD, MPH6, Rajendu Srivastava, MD, MPH7, Jenna Goldstein8, Maria-Lucia Campos9, Eric Howell, MD10, Christopher Landrigan, MD, MPH11, SHM I-PASS Study Group9, 1Boston Children's Hospital, Harvard Medical School, Boston, MA; 2Cincinnati Children's Hospital Medical Center/University of Cincinnati Medical Center, CINCINNATI, OH; 3Drexel University College of Medicine; 4University of San Francisco School of Medicine; 5Boston Children's Hospital, Harvard Medical School; 6Brigham and Women's Hospital, Harvard Medical School; 7Intermountain Healthcare; 8Society of Hospital Medicine; 9Boston Children's Hospital; 10Johns Hopkins Bayview Medical Center; 11Boston Children's Hospital , Harvard Medical School

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract number: Plenary presentation

Categories: Hospital Medicine 2018, Plenary Presentations

Keywords: , , ,

Background: Handoff miscommunications are a leading source of medical errors. Medical error and adverse event rates decreased following implementation of the I-PASS handoff program (a bundled intervention using a structured mnemonic, I-PASS, and other initiatives to sustain implementation) in a pediatric research trial. Whether I-PASS can be implemented in settings outside academic pediatric institutions is unknown.

Methods: Our objectives were 1) To implement I-PASS for resident physician end of shift handoffs in a variety of hospitals and medical specialties using a mentored process; and 2) To measure the association of I-PASS implementation with handoff quality and provider-reported medical error rates. We implemented I-PASS in 32 hospitals [community (n=12), academic (n=20)] and multiple specialties [internal medicine (n=13), pediatrics (n=12), other (n=7)]. We paired each site with an external mentorship team of I-PASS experts that conducted a site visit and provided ongoing monthly coaching. Site leads participated in program wide webinars and shared data with participating sites. Validated handoff observation tools and a provider survey assessed verbal and written handoff quality and rates of handoff-related adverse events.

Results: Across 32 participating hospitals, we assessed verbal handoff sessions of the giver (n=4176) and receiver (n=3385), reviewed printed handoff documents (n=1770), and distributed monthly end of rotation surveys (n=2081). Implementation was associated with increased inclusion of all 5 I-PASS mnemonic elements for both verbal (21% vs 64%; Figure 1) and written (10% vs 67%) handoffs. Additionally, increases were noted in the frequency of high quality verbal (31% vs 73%) and written (55% vs 71%) patient summaries, verbal (21% vs 71%) and written (42% vs 69%) contingency plans, and verbal receiver syntheses (47% vs 78%). Handoff-related adverse events decreased by 42% (Figure 2). All changes statistically significant (p<0.05). Improvements were similar across provider types (adult vs. pediatric) and settings (community vs. academic).

Conclusions: The I-PASS Handoff program is associated with improved handoff communication and patient safety across a variety of settings and provider types.

IMAGE 1:

IMAGE 2: Figure 2

To cite this abstract:

Starmer, AJ; O'Toole, JK; Spector, N; West, D; Sectish, T; Schnipper, J; Srivastava, R; Goldstein, J; Campos, M; Howell, E; Landrigan, C; Study Group, S. MENTORED IMPLEMENTATION OF THE I-PASS HANDOFF PROGRAM IN DIVERSE CLINICAL ENVIRONMENTS. Abstract published at Hospital Medicine 2018; April 8-11; Orlando, Fla. Abstract Plenary presentation. https://www.shmabstracts.com/abstract/mentored-implementation-of-the-i-pass-handoff-program-in-diverse-clinical-environments/. Accessed December 10, 2018.

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