School of Medicine and Health Sciences Poster Presentations

Title

IPASS These Patients To You

Poster Number

328

Document Type

Poster

Status

Medical Resident

Abstract Category

Quality Improvement

Keywords

Handoff, signout, IPASS, quality improvement

Publication Date

Spring 2018

Abstract

Quality, standardized sign-out between medical providers is integral to patient safety on an inpatient service. It has become increasingly important with restrictions to resident work hours. The IPASS handoff structure (i.e., illness severity, patient summary, action items, situational awareness and contingency planning, synthesis by receiver) has previously been established to reduce verbal and written miscommunications and errors when used and implemented within an education bundle (Sectish et al, Pediatrics 2011). Our aim was to utilize the IPASS structure to standardize the written handoff process between day and night teams in the internal medicine residency.

We performed seven PDSA cycles. The first PDSA cycle was sending an email to the interns on a single team explaining IPASS and how to use it. Uptake was the main barrier with the interns reporting it was burdensome. Handoffs were scored on a numerical scale correlated to incomplete, partially complete and complete. During the second cycle the resident on a single team interactively provided ongoing education on IPASS. The interns were more receptive to implementation in this cycle and furthermore the sign-outs were more complete (19% improvement). The next PDSA was to explore the impact of IPASS compared to the traditional handoff method on the night float interns, who completed a survey. The night float interns did not notice a large difference between traditional method and IPASS. Our next step was exploring resident uptake through asking two residents on different teams to implement IPASS. They received an email explaining IPASS and were asked to incorporate it into handoff of all new patients to the team. They successfully passed this message onto their interns. However, night float reported it was confusing to have mixed formats on the same team. We next attempted to implement it into the electronic system to reduce barriers to implementation but found this was not readily possible in discussion with IT. Next, in an effort to further justify IPASS, we completed another PDSA cycle of timing verbal handoff which averaged approximately 1 minute per patient. The last completed cycle was implementation of IPASS on an entire team with night float feedback which garnered good responses from the program.

In conclusion, these results are promising for the uptake of the validated IPASS sign-out format however implementation into current workflow remains the greatest barrier. Future work is focused on IT incorporation for IPASS.

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IPASS These Patients To You

Quality, standardized sign-out between medical providers is integral to patient safety on an inpatient service. It has become increasingly important with restrictions to resident work hours. The IPASS handoff structure (i.e., illness severity, patient summary, action items, situational awareness and contingency planning, synthesis by receiver) has previously been established to reduce verbal and written miscommunications and errors when used and implemented within an education bundle (Sectish et al, Pediatrics 2011). Our aim was to utilize the IPASS structure to standardize the written handoff process between day and night teams in the internal medicine residency.

We performed seven PDSA cycles. The first PDSA cycle was sending an email to the interns on a single team explaining IPASS and how to use it. Uptake was the main barrier with the interns reporting it was burdensome. Handoffs were scored on a numerical scale correlated to incomplete, partially complete and complete. During the second cycle the resident on a single team interactively provided ongoing education on IPASS. The interns were more receptive to implementation in this cycle and furthermore the sign-outs were more complete (19% improvement). The next PDSA was to explore the impact of IPASS compared to the traditional handoff method on the night float interns, who completed a survey. The night float interns did not notice a large difference between traditional method and IPASS. Our next step was exploring resident uptake through asking two residents on different teams to implement IPASS. They received an email explaining IPASS and were asked to incorporate it into handoff of all new patients to the team. They successfully passed this message onto their interns. However, night float reported it was confusing to have mixed formats on the same team. We next attempted to implement it into the electronic system to reduce barriers to implementation but found this was not readily possible in discussion with IT. Next, in an effort to further justify IPASS, we completed another PDSA cycle of timing verbal handoff which averaged approximately 1 minute per patient. The last completed cycle was implementation of IPASS on an entire team with night float feedback which garnered good responses from the program.

In conclusion, these results are promising for the uptake of the validated IPASS sign-out format however implementation into current workflow remains the greatest barrier. Future work is focused on IT incorporation for IPASS.