Addition of CORES to the I-PASS Handoff: A Resident-led Quality Improvement Study

Quality patient handoff is vital in patient care and attainable with structured handoff systems, such as the I-PASS mnemonic. This paper describes a continuous quality improvement study occurring after the implementation of the I-PASS handoff bundle. Our objectives were to (1) determine compliance with the inclusion of I-PASS elements during handoff and (2) determine whether the addition of CORES, an electronic tool that generates a patient list designed for use with I-PASS, would improve compliance and sustainability.

We developed an aim statement: 90% of handoffs would include all 6 I-PASS elements within 6 months of the addition of CORES. Two plan-do-study-act (PDSA) cycles were conducted. In PDSA 1, we implemented CORES. In PDSA 2, we reeducated residents on I-PASS elements and the importance of a quality handoff. We used a checklist to evaluate the inclusion of I-PASS elements. Following PDSA 2, we administered a survey regarding CORES to involved residents.

During PDSA 1, illness severity, diagnosis, patient summary, contingency planning, action list, and receiver synthesis were present in 13%, 62%, 52%, 87%, 42%, and 25% of handoffs, respectively. Overall compliance was 47%. During PDSA 2, illness severity remained stable at 13% whereas the remainder increased to 84%, 82%, 93%, 91%, and 37%. Overall compliance increased to 67%. Following PDSA 2, 100% of survey respondents reported improved handoff with CORES.

In this study, we show that neither implementation of CORES nor resident reeducation resulted in the return to high postintervention compliance observed after implementation of the I-PASS handoff bundle.