It’s increasingly clear that good health care is as much about communication as about using the best medical or surgical techniques. That’s especially true during the “handoff” – the transfer of a patient’s care from provider to provider during hospital shift changes. It’s a time when information is more likely to fall through the cracks or get distorted.
Now there’s solid proof that focusing on communications counts. Last week, The New England Journal of Medicine (NEJM) published a paper showing that implementing a set of handoff procedures and training tools led to a 30 percent drop in injuries from medical errors across the nine participating sites.
Boston Children’s Hospital, which led the study, took its I-PASS program to seven other pediatric hospitals and the Walter Reed Medical Center. I-PASS (think: “I pass this patient to you”) is a mnemonic that reminds clinicians of information to include in the handoff:
I: illness severity
P: patient summary (the standard clinical summary)
A: action list for the next team
S: situation awareness/contingency plans (things that can wrong and what should happen if they do)
S: synthesis: a chance for a “read-back” of the information by the provider being briefed
As anyone in health care knows, change doesn’t happen on a dime. Program leaders Christopher Landrigan, MD, MPH, and Amy Starmer, MD, MPH, worked closely with faculty and executives at the nine centers and with experts in curriculum development and administration to build I-PASS into hospital workflows. “We recognized that it would take a great deal of work to make the handoff program a sustainable system and encourage its adoption,” says Starmer.
I-PASS needn’t only involve clinicians. A new effort at Boston Children’s seeks to involve inpatient families in the handoff process with a nightly family sign-out sheet.
In the meantime, the I-PASS curriculum is openly available to any hospital wanting to use it at ipasshandoffstudy.com.
Join a discussion with the I-PASS authors in the NEJM Group Open Forum – a new feature just introduced by the journal – on Medstro.com, a social professional network for physicians. The forum is open for questions until Friday, November 21.
