LAS VEGAS – When the resident in the handoff training video approached another resident, she first vented about her “really crazy day” and how she’d been hoping to “get out of here on time for once.” Then, she tore through a case like an auctioneer, leaving out important details. At the end, she got a page and, of course, didn’t finish the handoff.
In Wednesday’s Quality Track session, “Strategies for Implementing a Successful Handoff” – with lessons from SHM’s I-PASS mentored implementation project – some attendees were eager to point out all of the flaws in the handoff. They were, however, slower to point to the good. For instance, the resident in the video made the effort to meet face-to-face and asked whether her colleague had any questions.
The audience had learned an important lesson about how to foster better handoffs, said, director of quality and safety programs at the University of California, San Francisco. He noted that it can be difficult to find the positives when the negatives are so glaring.
“This is one of the hard parts about doing feedback,” he said.
It was just one of many lessons taught in the session, also led by, a lecturer on pediatrics at Harvard Medical School, and , a pediatric hospitalist at Arkansas Children’s Hospital who was one of the I-PASS site leaders.
I-PASS was a nine-site study in the United States and Canada that found that using a bundle of interventions while doing handoffs resulted in a 30% reduction in preventable adverse events, meaning less harm to patients. The hallmark is the “I-PASS” mnemonic. It stands for:
- Illness severity – describing the stability level of a patient.
- Patient summary, including general information, such as the events leading to admission.
- Action list – essentially a to-do list for the patient.
- Situation awareness and contingency planning, which involves having a plan for what might happen.
- Synthesis by the receiver, in which the recipient of the information summarizes what was heard and asks questions.
Beyond that, the I-PASS system involves an introductory workshop, simulation exercises, structured observation and feedback, among other elements, Dr. Starmer said.
“This intervention was certainly not just a five-letter mnemonic,” she said.
The I-PASS Mentored Implementation Program, a collaboration with SHM that is funded by the Agency for Healthcare Research and Quality, is an effort to help implement a similar program in 32 hospitals in the United States.
Dr. Edgar-Zarate outlined the steps that worked at her site to make their I-PASS project successful. She said that project managers have to establish institutional support; assess a given center’s needs; gauge where to begin by identifying the most vulnerable transition points; find providers who will champion the project; establish good communication, in part by incorporating I-PASS into previously scheduled meetings; and collect data as time goes on.
Dr. Starmer directed attendees to, where anyone can download the material for free.
“This mentored implementation process,” she said, “has really been a helpful vehicle for disseminating the curriculum and implementation across different areas.”