Title: Large-scale implementation of the I-PASS handover system at an academic medical center
Clinical Question: Is a system-wide I-PASS handover system able to be effectively implemented?
Background: Handovers (also referred to as “handoffs”) in patient care are ubiquitous and are increasing, especially in academic medicine. Errors in handovers are associated with poor patient outcomes. I-PASS (Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver) is a handover system that is thought to improve efficiency and accuracy of handovers, however generalized roll-out within a large academic hospital remains daunting.
Setting: Academic medical center.
Synopsis: The authors recount a 3-year system-wide I-PASS implementation at their 999-bed major academic medical center. Effectiveness was measured through surveys and direct observations. Postimplementation surveys demonstrated a generally positive response to the implementation and training processes. Direct observation over 8 months was used to assess adoption and adherence to the handover method, and results showed improvement across all aspects of the I-PASS model, although the synthesis component of the handover consistently scored lowest. The authors noted that this is an ongoing project and plan future studies to evaluate effect on quality and safety measures.
Bottom Line: Implementing a system-wide handover change process is achievable, but will need to be incorporated into organizational culture to ensure continued use.
Citation: Shahian DM, McEachern K, Rossi L, et al. Large-scale implementation of the I-PASS handover system at an academic medical center. BMJ Qual Saf. 2017; doi: 10.1136/bmjqs-2016006195.
Dr. Rankin is a hospitalist and director of the family medicine residency inpatient service at the University of New Mexico.