Background and Objectives: Previous studies have emphasized the importance of effectual communication during patient handoffs. The objectives of this study were to (1) implement a resident-driven quality improvement project to improve handoffs by including key elements that are necessary for a safe and effective handoff. We chose to use the IPASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic as our standardized handoff model; (2) Consider balancing measures in an effort to be aware of any negative effects of our interventions on resident satisfaction with the system.
Methods: A senior resident established a quality improvement team which developed an AIM statement (a written, measurable, and time-sensitive description of the goal of a quality improvement team) and key drivers. A survey was administered to residents regarding their opinions about the handoff process. Tracking of whether or not handoffs included the component IPASS elements was performed over an 11-month period. During this time frame, three Plan-Do-Study-Act cycles were conducted. The first was an educational series involving lecture and role playing. The second was printed cards listing appropriate handoff elements. Intervention three was development of a tool and method to decrease nurse interruptions during handoff.
Results: Inclusion of six key elements of handoffs improved as follows. Illness severity improved from 5% to 97%, diagnosis from 60% to 100%, patient summary from 71% to 100%, contingency planning from 10% to 100%, action list from 23% to 100%, and receiver synthesis from 0% to 97%. Balancing measures showed the residents were more satisfied with the new system and found it to be more effective at providing a safe transition of care.
Conclusion: Implementation of a resident-driven multidisciplinary IPASS handoff system resulted in improved inclusion of key handoff elements and increased resident satisfaction.
Studeny S, Burley L, Cowen K, Akers M, O’Neill K, Flesher SL. Quality improvement regarding handoff. SAGE Open Medicine. 2017;5:2050312117729098. doi:10.1177/2050312117729098.