Regarding the initiative’s potential for reducing medical errors, a 2014 New England Journal of Medicine study showed that the I-PASS handoff bundle was associated with a 23 percent relative reduction in the overall medical error rate across nine training sites. “We need to see more ‘if … then’ statements-‘If this happens to the patient, then do this’-for the night resident who hasn’t been there all day.” “We’re doing better with the verbal handoffs, but I feel that sometimes our residents use the written handoffs as sort of a tally of what’s been going on with the patient’s hospitalization, as opposed to what the next person coming on shift needs to know and think about,” says Ngo. That, she adds, requires more “thinking ahead” in the written document about the patient’s needs after the handoff. Still, there’s room for improvement, says Ngo, who notes that a key goal of the mnemonic is for the handoff residents to achieve a “shared mental model” of the patient’s condition, care and treatment plan. “And the majority of our residents-over 90 percent-recognized that I-PASS is effective in enhancing patient safety.” “Recent data show our residents are using an evidence-based method for transferring information about patients during handoffs, which is helping to improve patient safety,” says Hughes. The results? Although the medical error rates before and after the intervention have not yet been reported, the quality of the written and oral handoff communications improved significantly with adherence to all elements in the I-PASS mnemonic since the start date. “We do the teaching, and faculty members observe the residents transferring care and assess whether they are using the mnemonic and the quality of the handoff communication.” “The mnemonic provides a standardized structure to improve how pediatric residents communicate with each other - both verbally and on paper - when transferring the care of a patient,” says chief resident Helen Hughes, who, with Thuy Ngo, associate director of the residency program, led I-PASS training at the Johns Hopkins Children’s Center. A mnemonic for handoff communication, I-PASS stands for illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver. To help reduce medical errors, the pediatric residency program at Johns Hopkins applied in 2016 to be part of a national quality improvement initiative called I-PASS. Indeed, the omission of critical information and the transfer of erroneous information during handoffs contribute to two of every three “sentinel events,” as reported in the April 2016 issue of the American Journal of Medical Quality. The team also learned that we needed more buy-in from the institution’s leaders for this QI project to be more successful.It’s no secret in the medical community that miscommunication during handoffs of patient care from one resident to another is a leading cause of serious medical errors. There was also a notable improvement in the percentage of handoff numbers for both the surgical and medical side. Our I-PASS percentage of handoffs also showed an increase from 40% to 50%, two months after implementation.
After our interventions, our results showed an increase in user satisfaction in the use of I-PASS.
Interventions included: education, tool modification, team meetings, and improving provider satisfaction in the use of I-PASS handoffs in EPIC. This QI project's primary objective was to improve the hospital-wide inpatient I-PASS handoff rate from 40% to 65% within two months following the interventions and improve provider satisfaction in using I-PASS handoffs in EPIC. This mnemonic stands for Illness severity, Patient summary, Action list, Situation awareness, and Synthesis by the receiver. I-PASS is one of the standardized tools for handoffs. Our electronic medical record system, EPIC, includes I-PASS handoff. Effective communication between caregivers can help reduce medical inpatient errors and preventable deaths due to miscommunication. In line with The Joint Commission on Accreditation of Healthcare Organization (JCAHO) as well as The Accreditation Council for Graduate Medical Education’s (ACGME) priorities for accreditation, our institution identified handoffs as an essential factor to consider in preventing risk to patients and process failure.
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