I-PASS tool enhances verbal handover on Pediatric General Surgery team
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1 I-PASS tool enhances verbal handover on Pediatric General Surgery team Lapidus-Krol E, Fallon E, Wolinska J, Kolivoshka Y, Fecteau A Division of General and Thoracic Surgery, Hospital For Sick Children, Toronto
2 No disclosure Disclosures
3 Background Miscommunication is the leading cause of adverse events in hospital No standardized handoff tool in pediatric surgery 2 teams of ped surg with cross coverage on nights/weekend 1 page census containing information for all patients followed by the service to help with handover
4 Pediatrics 2012; 129: 201-4
5 I-PASS Multicenter study: pediatric admissions Medical error rate decreased by 23% (24.5 vs 18.8/100 admissions, p<0.001) Preventable adverse events decreased by 30% ( 4.7 vs 3.3 events/100 admissions, p< 0.001) No change in non-preventable adverse events No change in duration of handoff per patient NEJM 2014; 371:
6 Objectives To develop a high quality pediatric surgical handoff program including structured communication and handoff curriculum tailored to pediatric surgeons To evaluate the effectiveness, accuracy and resident satisfaction of implementing I-PASS on a pediatric surgery service
7 Method QI approval Intervention: Training session on team communication strategies and I-PASS Implementation of I-PASS template for written handover document linked to EMR Implementation IPASS verbal handover Handovers with coaching on IPASS
8 Pre I-PASS written handover
9 Post I-PASS written handover
10 Methods Evaluation of completeness of verbal handoff pre and post intervention against elements of I-PASS sign off Illness severity Patient summary Action list Situation awareness Contingency planning Synthesis by receiver Accuracy was compared against the patient EMR 18 questions resident satisfaction survey pre and post intervention ( 5 points Lickhert scale)
11 Methods Results were analysed using T tests for continuous normally distributed variables or non-parametric Mann-Whitney U Tests Chi Square for nominal
12 Results 25 observations of verbal handover pre and post I-PASS implementation Handoff longer post I-PASS ( 24 vs 20 min, p=0.01)
13 Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Gender Post-op complications Tubes/drains Relevant medications Diet Investigations to be done Receiver ask questions Student t test
14 Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Gender <0.001 Post-op complications Tubes/drains Relevant medications Diet Investigations to be done Receiver ask questions Student t test
15 Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Illness severity < Age 6 95 < Diagnosis < Past medical hx 6 23 < Co-morbidity < Sx related info < Care plan < Call to do list < Call timeline Situation awarenesspossible event < Awareness- what to do < Receiver summary < Student t test
16 Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Illness severity < Age 6 95 < Diagnosis < Past medical hx 6 23 < Co-morbidity < Sx related info < Care plan < Call to do list < Call timeline Situation awarenesspossible event < Awareness- what to do < Receiver summary < Student t test
17 Results resident survey Significant difference pre and post I-PASS in* Understanding of disease process for patients Understanding of plans of care Understanding of tasks and priorities Understanding of contingency plans Confidence in ability to deal with call issues No significant difference in Interruption during handover Too much information All team members presence and participation *Chi-square p< 0.001
18 Limitations Hawthorne effect the resident survey was not a validated tool Did not evaluate impact on adverse events or medical errors
19 Conclusion I-PASS handoff method was implemented successfully on a surgical service Verbal handoff process was significantly improved with a structured communication tool Resident satisfaction significantly increased with the written and verbal I- PASS tools Sustainability requires Continued specialized training of new residents Continued validation of information on written I-PASS
20 Improvements post study Modification of the written I-PASS to meet surgical needs : Addition of daily measured weights Addition of diet (enteral and parenteral) Bedside PEWs score in illness severity Planned: paperless portable version
21 Improvements post study Development of a teaching video specific to our patient population
22 Thank you!
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