To enhance patient safety, many institutions have made improving patient handoffs a priority but research on the interventions used to attain this goal has been limited to single-center studies. A recent study published in JAMA by Amy J. Starmer, MD, MPH and colleagues found that bundling handoff interventions appeared to reduce medical error rates and improve communications between residents changing shifts at a single institution.
As a result of this study, Dr. Starmer and colleagues developed an enhanced bundle of handoff interventions centered around a new mnemonic to standardize oral and written handoffs. The mnemonic was I-PASS, which stands for illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver. Additional elements of the I-PASS handoff bundle included faculty development, observations of live handoffs, a visual reinforcement campaign, and training sessions that included simulation and role play exercises.
Improvements Seen in Patient Handoffs
More recently in a prospective study published in the New England Journal of Medicine, Dr. Starmer and colleagues examined the effect of the I-PASS program in pediatric inpatient units at nine academic hospitals. It measured rates of medical errors, preventable adverse events, and miscommunications, as well as resident workflow in more than 10,700 patient admissions. “A key finding of the study was that implementation of I-PASS was associated with a 23% reduction in the rate of overall medical errors and a 30% decrease in the rate of preventable adverse events,” Dr. Starmer says.
In addition, significant decreases were seen in rates of specific types of medical errors, including diagnostic errors. Furthermore, significant increases were seen in the inclusion of all pre-specified key elements in written documents and oral communication during handoff. “Importantly, the reductions in errors and improved handoff quality occurred without any changes in the duration of verbal handoffs or time spent at the computer or with patients,” adds Dr. Starmer.
Important Results in I-PASS Implementation
The findings build on those from single-institution studies showing that handoff-improvement programs can improve patient safety, but an important strength of this analysis is that it was effective at multiple study sites. “Knowing that the program worked in multiple settings, we can now say with confidence that other institutions can achieve similar success by implementation of similar bundled handoff interventions,” Dr. Starmer says. “The dissemination and implementation of similar programs has enormous potential to make a tremendous impact on patient safety.” She adds that the I-PASS program may potentially have a particularly significant impact because the communication skills emphasized in the program are important for all healthcare providers and settings.
Starmer AJ, Spector ND, Srivastava R, et al, for the I-PASS Study Group. Changes in medical errors after implementing of a handoff program. N Engl J Med. 2014;371:1803-1812. Available at: http://www.nejm.org/doi/full/10.1056/NEJMsa1405556#t=article.
I-PASS Study website. Available at http://www.ipasshandoffstudy.com.
Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC. I-PASS, a mnemonic to standardize verbal handoffs. Pediatrics. 2012;129:201-204.
Starmer AJ, O’Toole JK, Rosenbluth G, et al; the I-PASS Study Group. Development, implementation, and dissemination of the I-PASS handoff curriculum: a multisite educational intervention to improve patient handoffs. Acad Med. 2014;89:876-884.
DeRienzo CM, Frush K, Barfield ME, et al. Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program requirements. Acad Med. 2012;87:403-410.
Starmer AJ, Sectish TC, Simon DW, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. 2013;310:2262-2270.