Adapting the I-PASS Handoff Program for Emergency Department Inter-Shift Handoffs

Abstract

IntroductionAcademic emergency department (ED) handoffs are high-risk transfer of care events. Emergency medicine residents are inadequately trained to handle these vital transitions. We aimed to explore what modifications the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) handoff system requires to be effectively modified for use in ED inter-shift handoffs.MethodsThis mixed-method needs assessment conducted at an academic ED explored the suitability of the I-PASS system for ED handoffs. We conducted a literature review, focus groups, and then a survey. We sought to identify the distinctive elements of ED handoffs and discern how these could be incorporated into the I-PASS system.ResultsFocus group participants agreed the patient summary should be adapted to include anticipated disposition of patient. Participants generally endorsed the order and content of the other elements of the I-PASS tool. The survey yielded several wording changes to reflect contextual differences. Themes from all qualitative sources converged to suggest changes for brevity and clarity. Most participants agreed that the I-PASS tool would be well suited to the ED setting.ConclusionWith modifications for context, brevity, and clarity, the I-PASS system may be well suited for application to the ED setting. This study provides qualitative data in support of using the I-PASS tool and concrete suggestions for how to modify the I-PASS tool for the ED. Implementation and outcome research is needed to investigate if the I-PASS tool is feasible and improves patient outcomes in the ED environment.

Effective communication and sharing information at clinical handovers

“…The significant increase in the number of written documents and verbal communication at handovers improved communication without any negative impact on working methods. The mnemonic characteristics of I-PASS may also be acceptable in urgent care workplaces (Heilman et al, 2016), after making certain modifications that take into account their dynamic nature and time constraints. Mnemonic learning methods and structures for information transfer are also applied by tools based on the use of computer and web-operated systems.…”

Development and implementation of a standardised emergency department intershift handover tool to improve physician communication

“…Gopwani et al reported a similar positive experience with a locally developed handoff structure and implementation within a paediatric ED 30. Our decision was reinforced by the findings of Heilman et al , who explored the suitability of applying the illness severity, patient summary, action list, situational awareness, synthesis (I-PASS) mnemonic in an ED environment, and found that many modifications would be necessary to address the uniqueness of the ED population 31. Kicken et al concluded that the idea of completely standardising handover across different stakeholder groups was not realistic given clear differences in preferences of individual groups, and handover improvements necessary to account for physician specialty, level of training and other interprofessional groups such as nursing 32.…”

Standardized Reporting System Use During Handoffs Reduces Patient Length of Stay in the Emergency Department

“…A variety of reporting systems exist and have been reported as efficient handoff procedures linked closely to improved patient care outcomes [ 11 , 22 , 23 ]. As SBAR is widely recommended and externally validated, similar standards were adopted at the study ED yielding similar findings [ 24 - 26 ].…”

“…Additional studies have shown that patient care transition is more consistent and systemic with the implementation of standard reporting systems [ 7 , 8 ]. Aside from using a systemic report, identifying potentially high-risk patients during handoff procedures seems to play a critical role in reducing medical errors and improving outcomes [ 9 - 11 ]. Although prior studies have evaluated the use of standardized reporting systems between different specialties, there is scant literature evaluating standardized bedside handoff procedures in an ED setting [ 12 - 15 ].…”