Physician Transition of Care: Benefits of I PASS and an Electronic Handoff System in a Community Pediatric Residency Program.
BACKGROUND Miscommunication is a leading cause of adverse events in hospitals. Optimizing the handoff process improves communication and patient safety. We sought to assess how the components of I PASS (a mnemonic for illness severity, patient summary, action list, situational awareness with contingency planning, and synthesis by the receiver) a standardized handoff bundle, improved the quality of handoffs in a pediatric residency program based in a community hospital. METHODS Pediatric residents in a university affiliated community teaching hospital were observed on the pediatric inpatient floor and in the newborn nursery. One hundred resident handoffs per setting were analyzed in 3 phases, with a total of 600 handoffs assessed. Phase 1 comprised preintervention handoffs before I PASS; phase 2, initiating I PASS mnemonic and educational session; and phase 3, implementing a handoff tool, electronic physician handoff (EPH) into the electronic medical record. One attending physician at each setting assessed the handoff process using an 11 item survey. A resident satisfaction survey assessed the resident's experience after phase 3. RESULTS Comparing phase 1 with phase 2, there was improved situational awareness with contingency planning (nursery: 12% to 83% P .001; floor: 21% to 84% P .001) Incidence of tangential conversation decreased in both settings (nursery: 100% to 23% P .001; floor: 84% to 11% P .001) Comparing phase 2 with phase 3, there was improvement in identification of illness severity (nursery: 62% to 99% P .001; floor: 41% to 64% P .001) and fewer omissions of important information (nursery: 14% to 0% P .001; floor: 33% to 17% P .007) A total of 93% of residents found the new EPH system to be beneficial. CONCLUSIONS Specific components of a standardized handoff system, including a mnemonic, an educational intervention, and an EPH, improved the clarity and organization of key information in handoff.
Academic pediatrics