Pragmatic Study: Resident Verbal Handoffs Using I-PASS Reduces Adverse Patient Events During Transitions of Care

Background Transitions in care between resident physician teams represent a vulnerable time for hospitalized patients and are prone to increased adverse patient outcomes. Objective This prospective study evaluated whether a pragmatic, time-efficient intervention could decrease adverse patient outcomes during end-of-week transitions of care between inpatient resident teams. Methods From September 2022 to May 2024, following their first week of inpatient service, resident teams performed an unstructured written handoff to the next team (control group). At the end of their second inpatient week, the team performed a structured verbal handoff utilizing the I-PASS system (intervention group). Two days prior to their verbal handoff, residents received a 5- to 10-minute teaching session on the appropriate use of the I-PASS system. On switch days, 4 adverse patient events (primary composite endpoint) were collected including delays in patient discharge, delays in scheduled procedures, incomplete patient-to-physician communications, and major adverse patient events. Results A total of 3744 patients were evaluated: 2000 in the control group and 1744 in the intervention group. The composite endpoint incidence was 6.35% (127 of 2000) in the control group and 3.61% (63 of 1744) in the intervention group (X²=13.9, P=.002). This represented an absolute risk reduction of 2.74% (95% CI, 1.3-4.1) and a number needed to treat of 37 (95% CI, 24-75). Conclusions The implementation of a time-efficient structured verbal I-PASS handoff, when compared to an unstructured handoff, was associated with a decrease in number of adverse patient outcomes during end-of-week transitions of care.