Improving written handoff on inpatient medicine resident services: a resident-led safety initiative

High-quality, standardised handoff during shift change is a key aspect of reducing preventable medical errors. At our hospital, we noticed inconsistent use of the handoff tools built into the electronic health record. The goal of our project was to increase the percentage of completed written handoffs for all new admissions on resident teaching services by 50% in 8 weeks.

We designed a smart phrase tool based on the well-studied and validated I-PASS and taught all residents in small groups how to use it. We collected data weekly on the percentage of handoffs that were completed in the electronic health record. Measures were tracked via chart review and direct observation and uploaded on a run chart using Excel. Feedback was also gathered from residents and faculty.

We noted an upward trend in the percentage of written handoffs completed on new admissions postintervention, with the median preintervention rate of 31% and the median postintervention rate of 89% at 8 weeks, which remained sustained at the 4-month mark.

Our intervention improved the rates of written handoff completion based on the I-PASS handoff tool. It helped all members of the team feel more confident that they had the necessary information to care for patients and had the effect of reducing handoff time and improving satisfaction.