Improving Structured Handoff Documentation in a Pediatric Emergency Department

The I-PASS handoff tool guides provider handoffs and reduces adverse events in the inpatient setting. Transitions of care occur frequently in the emergency department (ED), and the unpredictable environment can lead to less structured handoffs. Our goal was to increase the percentage of handoff notes that include all 4 I-PASS components by 20% within 6 months.

We developed a handoff note template for the pediatric ED that included 4 key I-PASS elements: illness severity, patient care summary, action list, and situational awareness/contingency planning. Our primary outcome measure was the percentage of handoff notes that contained all 4 I-PASS elements. Our process measure was the percentage of handoff notes that used the template. Our balancing measure was the percentage of handoffs with no note. We analyzed a random sample of 20 charts monthly during our preimplementation (August 2021-July 2022) and postimplementation (August 2022-January 2024) phases. We completed monthly Plan-Do-Study-Act cycles to review note usage and identify obstacles to use. Process improvements included modifying the note template, enhancing accessibility within the electronic medical record, and designating computer workstations for completing handoff notes.

We assessed 240 handoff notes to determine the preimplementation baseline and evaluated 360 handoff notes postimplementation. Following implementation, 63.0% of handoff notes contained 4 I-PASS elements, compared with 0% before our intervention. Similarly, use of handoff templates increased to 82.0% from 0%. There was no change in handoffs without documentation.

Using a standardized note template for provider handoff improved adherence with the I-PASS handoff tool in the pediatric ED.