Evaluation of Novel Training and Data Summary Tool During Simulated En Route Care Patient Handoffs

Frequent handoff of combat casualties as patients move through echelons of care is a formidable challenge that may be improved using standardized structures and leveraging electronic health records to generate patient summary reports. The primary objective of this study was to conduct end-user evaluations of a novel didactic training and patient data summary prototype utilizing Illness Severity, Patient Summary, Action List, Situational Awareness, and Synthesis by Receiver (IPASS) structure during simulated Critical Care Air Transport patient handoffs. A secondary objective was to compare the number of critical items transferred and adherence to handoff practices for usual care (UC) versus the intervention bundle.

A prospective, tabletop, one-way crossover simulation was conducted with 2-person teams of internal medicine residents and interns. Participants completed a handoff of 2, critically injured combat wounded using usual training and documentation. Participants then switched sender and receiver roles to handoff 2 new patients using structured handoff training and a novel data summary tool (intervention arm). We assessed user feedback via narrative comments, an 8-item handoff satisfaction survey, and an 8-item usability survey for both systems. We calculated descriptive statistics as median [IQR]; comparisons were performed with Student's t-test and Wilcoxon as appropriate.

We analyzed feedback from 44 participants. Self-assessed overall handoff quality scores were significantly higher in the intervention group compared to UC for both senders (80.0 [75.0-87.5] vs. 70.0 [62.5-75.0]), P < .001) and receivers (85.7 [80.0-97.9] vs. 74.3 [62.9-80.0], P < .001). Likewise, overall handoff usability scores were significantly higher in the intervention group compared to UC for both senders (80.0 [74.4-85.0] vs. 45.0 [40.0-59.4], P < .001) and receivers (82.5 [79.4-97.5] vs. 50.0 [45.0-56.3]). The majority of participants described the intervention bundle as "easier, better, or superior" to the current standard of care. A higher proportion of critical items per patient were transferred in the intervention group (83.4%) versus UC (71.6%, P = .001).

End users reported greater documentation system usability and handoff satisfaction with a bundle of structured IPASS training and a data summary prototype compared to usual practice. Intervention bundle handoffs verbally transferred a higher proportion of critical items. The introduction of electronic medical records into operational medicine offers an opportunity to improve handoff safety. Future research should evaluate bundles of IPASS training and automatically generated data summary prototypes in operational settings.