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However, is the lack of association of I-PASS implementation with clinical outcomes and adverse events in this study a concern? To answer this question, it is necessary to review the origins of I-PASS more than a decade ago and its continually expanding evidence base. Thus, consistent with all previous studies, I-PASS was implemented successfully and handover quality improved. From the provider perspective, preintervention and postintervention Agency for Healthcare Research and Quality (AHRQ) safety culture surveys did not show significant differences in their responses to communication-focused questions before and after the intervention. Regarding balancing measures, there was no observed difference in the ‘full-shift’ handover duration (control 35.7 min (29.6–41.8) intervention 34.7 min (26.5–42.1), p=0.490), although more time was spent on individual patient handovers in the intervention period (7.29 min (5.77–8.81) control 5.96 min (4.69–7.23) p=0.001). Notably, however, on the primary outcome there were no differences between control and intervention groups regarding preventable adverse events per 1000 days of hospitalisation (control 60.4 (37.5–97.4) vs intervention 60.4 (33.2–109.9), p=0.998, risk ratio: 1.0 (0.74–1.34)). Study results demonstrated significantly improved handover compliance in the intervention group, validating Kirkpatrick Level 3 (behavioural change) 2 effectiveness of the training initiative. According to the authors, prior to the intervention there were complaints that handovers were ‘…lengthy, disorganized, …participants experienced problems with interruptions, distractions, and … senior professionals had problems accepting dissent’.Īdverse events were assessed by two independent reviewers using the Global Assessment of Pediatric Patient Safety instrument.
Ipass medical handoff trial#
In the next phase of our project we will be measuring trends in reduction in medical errors since implementation.In this issue of BMJ Quality and Safety, Jorro-Barón and colleagues 1 report the findings of a stepped-wedge cluster randomised trial (SW-CRT) to evaluate the implementation of the I-PASS handover system among six paediatric intensive care units (PICUs) at five Argentinian hospitals between July 2018 and May 2019. We successfully implemented IPASS without any added infrastructure cost. Conclusions: Implementation of an electronic handoff tool in the absence of an EMR with minimal resources is a major breakthrough and can be replicated in other low-resource settings. Post-Implementation results showed that the resident dissatisfaction has gone down to less than 5%. Weekly compliance audits after initial pilot demonstrated a 100% compliance. Results: Pre-implementation survey revealed 74% resident and 87% faculty dissatisfaction with the current handoff process. Following a four-week pilot this was expanded to other sub specialties, and a pre and post intervention survey was conducted to assess its impact. Implementation included sensitizing residents to the IPASS template, hands-on training, weekly feedback from the residents, directly observed hand-off by the chief and/or senior resident. This allowed remote access, multiple simultaneous inputs, authenticated use and user-specific access control. Microsoft Sharepoint (Microsoft, Redmond, WA) was used to develop a tabulated online portal incorporating patient demographic, clinical and laboratory details with physician remarks. A standardized electronic handoff tool (IPASS) was identified, and significantly modified to fit our needs, since we do not have a complete electronic medical record (EMR). Methods: Pre-intervention, handoff entailed the physical handover of handwritten notes, carbon copied for various team members. A safe and efficient means of exchange of medical information between care teams via a standardized handoff system is essential, especially in high intensity fields such as Pediatric Hematology/Oncology. Inefficient handoff is labor intensive and time consuming, impacting the quality of patient care provided. Background: Communication failure is the most common preventable cause of medical adverse event, and almost half of all sentinel events involve handoff failure.