TY - JOUR
T1 - Implementation of the I-PASS handoff program in diverse clinical environments
T2 - A multicenter prospective effectiveness implementation study
AU - the I-PASS SHM Mentored Implementation Study Group
AU - Starmer, Amy J.
AU - Spector, Nancy D.
AU - O'Toole, Jennifer K.
AU - Bismilla, Zia
AU - Calaman, Sharon
AU - Campos, Maria Lucia
AU - Coffey, Maitreya
AU - Destino, Lauren A.
AU - Everhart, Jennifer L.
AU - Goldstein, Jenna
AU - Graham, Dionne A.
AU - Hepps, Jennifer H.
AU - Howell, Eric E.
AU - Kuzma, Nicholas
AU - Maynard, Greg
AU - Melvin, Patrice
AU - Patel, Shilpa J.
AU - Popa, Alina
AU - Rosenbluth, Glenn
AU - Schnipper, Jeffrey L.
AU - Sectish, Theodore C.
AU - Srivastava, Rajendu
AU - West, Daniel C.
AU - Yu, Clifton E.
AU - Landrigan, Christopher P.
AU - Edgar-Zarate, Courtney
AU - Boa-Hocbo, Aileen
AU - Zampino, Dominick
AU - Rosenbluth, Glenn
AU - West, Daniel C.
AU - Campos, Maria Lucia
AU - Melvin, Patrice
AU - Graham, Dionne A.
AU - Landrigan, Christopher P.
AU - Sectish, Theodore C.
AU - Starmer, Amy J.
AU - Menon, Aravind Ajakumar
AU - Sloan, Karin A.
AU - Patel, Rajesh
AU - Mueller, Stephanie
AU - Schnipper, Jeff
AU - Eagle, Steven
AU - Marrese, Christine
AU - Serra, Theresa
AU - Etzenhouser, Angie
AU - Mann, Keith
AU - Riss, Robert
AU - Seltz, Barry
AU - Galardy, Paul
AU - Huskins, Charles
N1 - Publisher Copyright:
© 2022 Society of Hospital Medicine.
PY - 2023/1
Y1 - 2023/1
N2 - Background: Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. Objective: To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. Design: Prospective Type 2 Hybrid effectiveness implementation study. Settings and Participants: Residents from diverse specialties across 32 hospitals (12 community, 20 academic). Intervention: External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. Main Outcome and Measures: Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality. Results: 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p <.05) and 17.5 to 9.3 minor events/person-year (p <.001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p <.001, n = 4812) and written (10% vs. 74%, p <.001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p <.001) and written (29% vs. 78%, p <.001) patient summaries, verbal (29% vs. 78%, p <.001) and written (24% vs. 73%, p <.001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p <.001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).
AB - Background: Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. Objective: To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. Design: Prospective Type 2 Hybrid effectiveness implementation study. Settings and Participants: Residents from diverse specialties across 32 hospitals (12 community, 20 academic). Intervention: External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. Main Outcome and Measures: Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality. Results: 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p <.05) and 17.5 to 9.3 minor events/person-year (p <.001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p <.001, n = 4812) and written (10% vs. 74%, p <.001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p <.001) and written (29% vs. 78%, p <.001) patient summaries, verbal (29% vs. 78%, p <.001) and written (24% vs. 73%, p <.001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p <.001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).
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U2 - 10.1002/jhm.12979
DO - 10.1002/jhm.12979
M3 - Article
C2 - 36326255
AN - SCOPUS:85143838753
SN - 1553-5592
VL - 18
SP - 5
EP - 14
JO - Journal of hospital medicine
JF - Journal of hospital medicine
IS - 1
ER -