November 30, 2014
Contrary to a common sentiment (and oft-reality) in medicine that new change will make existing processes take longer, researchers have proven that standardized handoffs, which they have (also) proven reduce medical errors and adverse events, actually take no longer than the status quo.
A paper in a recent edition of the New England Journal of Medicine reported findings from a prospective multi-center trial, which examined the impact of a provider handoff intervention. The study, dubbed I-PASS, included nine US academic medical centers and was carried out on the inpatient pediatric wards. The intervention entailed the use of a mnemonic to structure the verbal and written components of handoffs as part of what researchers call a ‘resident-training-bundle.’ The 'resident-training-bundle' not only included the mnemonic and teamwork and communication skills training, but also i) training the attending physician faculty members to observe and coach residents on how to conduct standardized handoff communications and ii) a ‘sustainability’ campaign which required the buy-in of the academic medical center leadership.
At each participating facility, an initial phase of the study was carried out, during which a baseline medical error and adverse event rates were determined. In addition, the frequency with which the content of verbal and written handoff communications included key components was assessed as was the time it took providers on average to conduct handoffs, including time at the computer. After the implementation of the intervention, the error and adverse event rates were again assessed, as was the content of verbal and written handoff communications and the time it took providers to do each handoff using the new standardized approach.
The researchers found that, on average, the handoffs took no longer to conduct than they did using the status quo handoff workflow. However, the use of the standardized approach lead a large reduction in medical errors and adverse events, to the tune of 23 percent and 30 percent respectively.