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Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in
Facundo Jorro-Barón1,2, Inés Suarez-Anzorena3, Rodrigo Burgos-Pratx4
1Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina fjorro@iecs.org.ar.
Insights
Implementing the I-PASS handoff bundle in pediatric intensive care units improved handoff compliance but did not reduce adverse events or enhance communication perception.
Area of Science:
- Medical quality improvement
- Patient safety
- Healthcare delivery
Background:
- Limited research exists on handoff quality and adverse events (AEs) in low- and middle-income countries.
- Handoff improvement programs require rigorous evaluation.
Purpose of the Study:
- To evaluate the effectiveness of a handoff program in reducing AE frequency in pediatric intensive care units (PICUs).
Main Methods:
- A facility-based, cluster-randomised, stepped-wedge trial was conducted in six Argentine PICUs.
- The intervention involved the Spanish version of the I-PASS handoff bundle, including teamwork training and simulation.
- Medical records were reviewed for AEs, and handoffs were observed for compliance and duration.
Main Results:
- No significant difference was observed in preventable AE rates per 1000 hospitalisation days between control and intervention groups.
- Compliance with verbal and written handoff items significantly increased in the intervention group.
- Handoff duration and providers' perception of improved communication remained unchanged.
Conclusions:
- The I-PASS bundle implementation enhanced handoff compliance in PICUs.
- The study did not find a reduction in AE frequency or an improvement in communication perception.
- Further research may be needed to optimize handoff interventions in similar settings.
Background:
There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes' effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs).
Methods:
Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation.
Results:
We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5-97.4) vs intervention 60.4 (33.2-109.9), p=0.99, risk ratio: 1.0 (0.74-1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6-41.8) vs intervention 34.7 min (26.5-42.1); difference 1.43 min (95% CI -2.63 to 5.49, p=0.49)). The providers' perception of improved communication did not change.
Conclusions:
After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs' frequency or the perception of enhanced communication.
Trial Registration Number:
NCT03924570.
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