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Real-World Implementation of a Standardized Handover Program (I-PASS) on a Pediatric Clinical Teaching Unit

      Abstract

      Objective

      A standardized handover curriculum (I-PASS) has been shown to reduce preventable adverse events in a large multicenter study. We aimed to study the real-world impact of the implementation of this curriculum on handover quality, duration, and identification of unstable patients.

      Methods

      A prospective intervention study was conducted. We implemented the I-PASS curriculum via faculty education and resident workshops. Resident handover on the clinical teaching unit was videorecorded, and written handover documents were collected for 2 weeks before and after the intervention. We examined the inclusion of key elements on handover documents before and after intervention using logistic regression models accounting for multiple handovers per patient. Duration of handover was compared using a linear regression model adjusting for number of patients. Qualitative content analysis was used to describe observable differences in verbal handover recordings and written critical care consultations.

      Results

      A total of 1275 handovers were included, comprising 364 inpatients. There was a significant increase (P < .05) in 7 of 11 key elements and a significant decrease in written physical examination findings after the intervention. No significant change was found in handover duration. Qualitative video analysis revealed observable differences in handover collaboration and organization. After the intervention, patients with critical care needs overnight were correctly identified as requiring close monitoring during handover.

      Conclusions

      Handover training resulted in consistent inclusion of key elements and was characterized by collaboration between participants and improved organization without significant increase in handover duration. Appropriate identification and response to clinically deteriorating patients was also found using the I-PASS model.

      Keywords

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      References

      1. Joint Commission. Sentinel event data root causes by event type. Available at: https://www.jointcommission.org/sentinel_event_statistics/. Accessed September 4, 2015.

        • Riesenberg L.A.
        • Leitzsch J.
        • Massucci J.L.
        • et al.
        Residents' and attending physicians' handoffs: a systematic review of the literature.
        Acad Med. 2009; 84: 1775-1787
        • Cohen M.D.
        • Hilligoss B.
        • Kajdacsy-Balla Amaral A.
        A handoff is not a telegram: an understanding of the patient is co-constructed.
        Crit Care. 2012; 16: 303
        • Horwitz L.
        • Schuster K.
        • Thung S.
        • et al.
        An institution-wide handoff task force to standardise and improve physician handoffs.
        BMJ Qual Saf. 2012; 21: 863-871
        • Arora V.
        • Johnson J.
        • Lovinger D.
        • et al.
        Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis.
        Qual Saf Health Care. 2005; 14: 401-407
        • Solet D.J.
        • Norvell J.M.
        • Rutan G.H.
        • et al.
        Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs.
        Acad Med. 2005; 80: 1094-1099
        • Frank J.R.
        • Snell L.
        • Sherbino J.E.
        The draft CanMEDS 2015 physician competency framework—series IV.
        Royal College of Physicians and Surgeons of Canada, Ottawa, Canada2015: 8 (Available at:) (Accessed September 8, 2015)
      2. Accreditation Council for Graduate Medical Education. ACGME common program requirements. Available at: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed September 19, 2015.

        • Abraham J.
        • Kannampallil T.
        • Patel V.L.
        A systematic review of the literature on the evaluation of handoff tools: implications for research and practice.
        J Am Med Inform Assoc. 2014; 21: 154-162
        • Gordon M.
        • Findley R.
        Educational interventions to improve handover in health care: a systematic review.
        Med Educ. 2011; 45: 1081-1089
        • Starmer A.J.
        • Spector N.D.
        • Srivastava R.
        • et al.
        Changes in medical errors after implementation of a handoff program.
        N Engl J Med. 2014; 371: 1803-1812
        • Starmer A.J.
        • O'Toole J.K.
        • Rosenbluth G.
        • et al.
        Development, implementation, and dissemination of the I-PASS handoff curriculum.
        Acad Med. 2014; 89: 876-884
        • Starmer A.
        • Spector N.
        • Srivastava R.
        • et al.
        I-PASS, a mnemonic to standardize verbal handoffs.
        Pediatrics. 2012; 129: 201-204
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • et al.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Starmer A.J.
        • Sectish T.C.
        • Simon D.W.
        • et al.
        Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.
        JAMA. 2013; 310: 2262
        • Hsieh H.F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Arora V.M.
        • Johnson J.K.
        • Meltzer D.O.
        • et al.
        A theoretical framework and competency-based approach to improving handoffs.
        Qual Saf Health Care. 2008; 17: 11-14
        • Charap M.
        Reducing resident work hours: unproven assumptions and unforeseen outcomes.
        Ann Intern Med. 2004; 140: 814-815
        • Petersen L.
        • Brennan T.
        • O'Neil A.
        • et al.
        Does housestaff discontinuity of care increase the risk for preventable adverse events?.
        Ann Intern Med. 1994; 121: 866-872
        • Horwitz L.I.
        • Moin T.
        • Krumholz H.M.
        • et al.
        Consequences of inadequate sign-out for patient care.
        Arch Intern Med. 2008; 168: 1755-1760
        • Bigham M.T.
        • Logsdon T.R.
        • Manicone P.E.
        • et al.
        Decreasing handoff-related care failures in children's hospitals.
        Pediatrics. 2014; 134: e572-e579
        • Abraham J.
        • Kannampallil T.G.
        • Almoosa K.F.
        • et al.
        Comparative evaluation of the content and structure of communication using two handoff tools: implications for patient safety.
        J Crit Care. 2014; 29: 311.e1-311.e7
        • Horwitz L.I.
        • Moin T.
        • Krumholz H.M.
        • et al.
        What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff.
        Qual Saf Health Care. 2009; 18: 248-255
        • Greenstein E.
        • Arora V.
        • Staisiunas P.
        • et al.
        Characterising physician listening behaviour during hospitalist handoffs using the HEAR checklist.
        BMJ Qual Saf. 2013; 22: 203-209
        • McMullan A.
        • Parush A.
        • Momtahan K.
        Transferring patient care: patterns of synchronous bidisciplinary communication between physicians and nurses during handoffs in a critical care unit.
        J Perianesth Nurs. 2015; 30: 92-104
        • Patterson E.S.
        • Roth E.M.
        • Woods D.D.
        • et al.
        Handoff strategies in settings with high consequences for failure: lessons for health care operations.
        Int J Qual Health Care. 2004; 16: 125-132
        • Rayo M.F.
        • Mount-Campbell A.F.
        • O'Brien J.M.
        • et al.
        Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners.
        BMJ Qual Saf. 2014; 23: 483-489
        • Abraham J.
        • Kannampallil T.G.
        • Patel V.L.
        Bridging gaps in handoffs: a continuity of care based approach.
        J Biomed Inform. 2012; 45: 240-254
        • Helms A.S.
        • Perez T.E.
        • Baltz J.
        • et al.
        Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.
        J Gen Intern Med. 2012; 27: 287-291
        • Chang V.Y.
        • Arora V.M.
        • Lev-Ari S.
        • et al.
        Interns overestimate the effectiveness of their hand-off communication.
        Pediatrics. 2010; 125: 491-496