I-PASS-Based Handoff Pilot in a High-Volume Urban Hospital: Benefits and Barriers for Hospitalists

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Medical Education

Background:

• The I-PASS bundle is a standardized handoff protocol widely adopted in residency training.
• Sustainable use of I-PASS components by attending hospital medicine providers requires investigation.
• A pilot of an I-PASS-based handoff tool showed high provider satisfaction but low utilization.

Purpose of the Study:

• To explore attending physicians' and Advanced Practice Providers' perceptions of an I-PASS-based handoff tool.
• To understand the gap between perceived utility and actual infrequent use of the pilot handoff tool.

Main Methods:

• Qualitative study using individual interviews and focus groups with 13 attending hospitalist physicians and Advanced Practice Providers.
• Interviews conducted from February to March 2022.
• Transcribed recordings were qualitatively coded with high interrater agreement (κ = 0.82).

Main Results:

• Participants found the I-PASS-based tool suboptimal but acknowledged increased awareness and use of handoff processes.
• Recommendations included: quick information delivery for cross-cover, less detail for stable patients, and utilizing existing EMR chat/notes.
• Other suggestions: standardize formats, gain provider buy-in, educate on efficient tool use, and set explicit expectations for handoff completion.

Conclusions:

• Handoffs are critical for patient safety.
• Despite suboptimal perceptions of the pilot tool, the initiative enhanced awareness and use of handoff processes.
• Contextual adaptation of I-PASS bundle components may be necessary for successful implementation.