I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration.

Area of Science:

• Medical informatics
• Patient safety
• Clinical risk assessment

Background:

• The I-PASS framework is increasingly adopted for patient handoffs to reduce medical errors.
• A critical element of I-PASS is assigning illness severity to patients.
• This study investigates the utility of these severity assignments.

Purpose of the Study:

• To evaluate if illness severity categories can predict patients at higher risk of overnight clinical deterioration.
• To assess if these categories correlate with rapid response team (RRT) activations.

Main Methods:

• Retrospective review of I-PASS handoff documentation and overnight RRT activations.
• Analysis of illness severity categories, vital signs, and patient outcomes.
• Statistical evaluation of RRT activation risk based on severity categories.

Main Results:

• Over 28,000 handoffs were reviewed; 1.3% 'star', 18.8% 'watcher', 79.9% 'stable'.
• Of 98 RRT activations, 5.1% were 'star', 35.7% 'watcher', 59.2% 'stable'.
• Patients categorized as 'watcher' (OR 2.6) and 'star' (OR 5.2) had significantly higher odds of overnight RRT activation compared to 'stable' patients.

Conclusions:

• The illness severity component of I-PASS effectively identifies patients at increased risk of overnight clinical deterioration.
• This classification system aids overnight residents in prioritizing patient care.
• Potential to improve patient outcomes by enabling proactive interventions.