The primary outcome was a change in the DoP staff physician "handoffs and transitions" score on the Agency for Healthcare Quality (AHRQ) Hospital Survey on Patient Safety Culture. The setting was the Department of Pediatrics (DoP) within a tertiary academic children's hospital encompassing 13 clinical divisions. We used a modified learning collaborative model to implement an I-PASS program, including training, standardized verbal handoff processes, observation and feedback, and sustainment. We sought to improve physician handoffs and safety culture scores by implementing standardized handoff communication across multiple divisions of an academic pediatric department. A safety culture survey showed that "handoffs and transitions" were among the lowest scoring dimensions at our hospital. Structured handoffs at transitions of care are vital components of patient safety. Starmer, MD, MPH, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Mail code: CDRCP, 707 SW Gaines St, Portland, OR 97239-2998.
In this report, we emphasize the importance of structured communication strategies to enhance patient safety, review literature pertinent to the handoff process, including the use of verbal mnemonics, and describe the creation of …Īddress correspondence to Amy J. Effective mnemonics are catchy, symbolic, parsimonious, utilitarian, and may conjure up a visual image linked to a process or subject. Individual elements of the I-PASS mnemonic will be defined in this article. The title I-PASS is an acronym that not only denotes the title and purpose of our research study-IIPE-PRIS Accelerating Safe Sign-outs-but also serves as the verbal mnemonic for the standardized handoff itself. This multisite collaborative education and research project was launched with the support of the Initiative for Innovation in Pediatric Education (IIPE) and the Pediatric Research in Inpatient Settings (PRIS) network. The I-PASS Study aims to determine the effectiveness of implementing a “resident handoff bundle” to standardize inpatient transitions in care and decrease medical errors in 10 pediatric institutions.1 The resident handoff bundle includes 3 major elements: team training by using focused TeamSTEPPS communication strategies,2 implementation of a standardized template for the written or printed computerized handoff document, and introduction of several evidence-based verbal handoff processes, which are referred to by using a novel verbal mnemonic. Because miscommunications are a leading cause of adverse events in hospitals, optimizing the handoff process is essential for patient safety.
New duty hours standards have increased the frequency of transitions in care or handoffs for resident physicians. The lesson about the importance of context is critical in adopting and adapting innovations to your own learning environment. We bring you this article in the spirit of sharing what works and what doesn't. The first cohort of IIPE projects from 2009 are beginning to realize some early successes.