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 - Kothari, Lara
AU - Vaniawala, Vishwas
N1 - Funding Information:
The authors would like to express their sincere appreciation to the resident physicians, faculty, patients, and families who participated in the project as well as to the Pediatric Research in Inpatient Settings (PRIS) Network and the Society for Hospital Medicine for their support in facilitating the project. The SHM I‐PASS Study was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ, R18 HS23291‐01).
Funding Information:
In our prior nine‐center pediatric study, preventable adverse events decreased by 30% after implementation of I‐PASS. In the current effectiveness implementation study, we extended this work by adapting and implementing I‐PASS for adult patients and resident physicians in academic and community hospital settings. By design, we rolled the program out without the robust funding for personnel and data collection efforts that supported our prior clinical trial, to determine if sites could successfully implement it with more limited financial support, though the study did provide external coaching and infrastructure. Additionally, sites were primarily responsible for rolling the intervention out locally and for funding their personnel.
Funding Information:
The authors would like to express their sincere appreciation to the resident physicians, faculty, patients, and families who participated in the project as well as to the Pediatric Research in Inpatient Settings (PRIS) Network and the Society for Hospital Medicine for their support in facilitating the project. The SHM I-PASS Study was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ, R18 HS23291-01).
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).
UR - http://www.scopus.com/inward/record.url?scp=85143838753&partnerID=8YFLogxK
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 -
