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Implementation of ED I-PASS as a Standardized Handoff Tool in the Pediatric Emergency Department
Insights
Implementing the Expected Disposition, Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver (ED I-PASS) tool significantly reduced information loss during patient handoffs in pediatric emergency medicine. This quality improvement initiative enhanced communication and patient safety.
Area of Science:
- Medical error reduction
- Quality improvement initiatives
- Healthcare communication
Background:
- Patient handoffs are critical for care continuity, yet communication failures during these transitions are a major source of medical errors.
- Standardized tools for intershift handoffs in pediatric emergency medicine (PEM) are lacking, necessitating the development of effective communication strategies.
Purpose of the Study:
- To improve patient handoffs between attending physicians in pediatric emergency medicine (PEM) by implementing a modified I-PASS tool (ED I-PASS).
- To increase the utilization of the ED I-PASS tool and decrease the incidence of information loss during shift changes.
Main Methods:
- The Expected Disposition, Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver (ED I-PASS) tool was implemented using iterative Plan-Do-Study-Act cycles.
- Intervention involved training "super-users," providing cognitive support tools, direct observation, and feedback during the COVID-19 pandemic.
Main Results:
- Physician use of the ED I-PASS tool increased significantly from 7.1% to 87.5% (p < .001).
- Reported perceived loss of important patient information during transitions of care decreased by 50% (from 75.0% to 37.5%, p = .02).
- Most participants (76.0%) reported satisfaction with the ED I-PASS tool.
Conclusions:
- The ED I-PASS tool can be successfully implemented among attending physicians in pediatric emergency departments.
- Implementation of ED I-PASS led to a significant reduction in perceived patient information loss during intershift handoffs, enhancing patient safety.
Introduction:
Communication, failures during patient handoffs are a significant cause of medical error. There is a paucity of data on standardized handoff tools for intershift transitions of care in pediatric emergency medicine (PEM). The purpose of this quality improvement (QI) initiative was to improve handoffs between PEM attending physicians (i.e., supervising physicians ultimately responsible for patient care) through the implementation of a modified I-PASS tool (ED I-PASS). Our aims were to: (1) increase the proportion of physicians using ED I-PASS by two-thirds and (2) decrease the proportion reporting information loss during shift change by one-third, over a 6-month period.
Methods:
After literature and stakeholder review, Expected Disposition, Illness Severity, Patient Summary, Action List, Situational Awareness, Synthesis by Receiver (ED I-PASS) was implemented using iterative Plan-Do-Study-Act cycles, incorporating: trained "super-users"; print and electronic cognitive support tools; direct observation; and general and targeted feedback. Implementation occurred from September to April of 2021, during the height of the COVID-19 pandemic, when patient volumes were significantly lower than prepandemic levels. Data from observed handoffs were collected for process outcomes. Surveys regarding handoff practices were distributed before and after ED I-PASS implementation.
Results:
82.8% of participants completed follow-up surveys, and 69.6% of PEM physicians were observed performing a handoff. Use of ED I-PASS increased from 7.1% to 87.5% ( p < .001) and the reported perceived loss of important patient information during transitions of care decreased 50%, from 75.0% to 37.5% ( p = .02). Most (76.0%) participants reported satisfaction with ED I-PASS, despite half citing a perceived increase in handoff length. 54.2% reported a concurrent increase in written handoff documentation during the intervention.
Conclusion:
ED I-PASS can be successfully implemented among attending physicians in the pediatric emergency department setting. Its use resulted in significant decreases in reported perceived loss of patient information during intershift handoffs.
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