December 14, 2014
A report of the findings from a prospective study appearing in the Journal of the American Medical Association (JAMA) on December 13, 2014, found that standardizing handoff communications can significantly reduce the rate of preventable medical errors in the pediatric inpatient academic medical setting. The authors report their findings from the study, which was carried out in 2009 and 2010 on two inpatient units at Boston Children’s Hospital.
In the study, an intervention, dubbed ‘I-PASS’ was implemented via a ‘Resident Training Bundle’ and utilized standardized handoff reports and verbal communications, both of which were based on the I-PASS mnemonic. The study included data from 1,255 patient admissions and involved 84 pediatric resident physicians. A period before and after the intervention was examined and the authors found that the intervention reduced the rate of preventable medical errors by 45.8 percent (33.8 to 18.3 medical errors per 100 admissions) and the rate of adverse events by 54.5 percent (3.3 to 1.5 adverse events per 100 admissions). They also found that the use of a computerized handoff tool led to significant reductions in the omission of standardized elements deemed to be important for effective handoff communications in 11 of 14 categories. After the intervention, as compared to before, the authors also found that handoffs were more likely to be performed in quiet locations limiting the opportunity for disruptions and distractions. Equally important, the study found that the time it took study participants to ‘give signout’ in the post intervention period was no different than the time it took pre intervention. Essentially, standardizing handoff communications did not increase the time it took the doctors to handoff patients at shift changes.
The authors sum up their findings stating that the I-PASS handoff process when implemented with the Resident Training Bundle in an academic medical setting on inpatient pediatric wards: i) significantly reduces medical errors and adverse events, ii) improves the quality of handoff communications by a) increasing the frequency with which data that ideally should be communicated at signouts gets communicated and b) decreasing the incidence of interruptions during signouts, and iii) takes no longer than the status quo process of handing off patients prior to the intervention.