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
No disclosure Disclosures
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
Pediatrics 2012; 129: 201-4
I-PASS Multicenter study: 10740 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: 1803-1812
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
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
Pre I-PASS written handover
Post I-PASS written handover
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)
Methods Results were analysed using T tests for continuous normally distributed variables or non-parametric Mann-Whitney U Tests Chi Square for nominal
Results 25 observations of verbal handover pre and post I-PASS implementation Handoff longer post I-PASS ( 24 vs 20 min, p=0.01)
Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Gender 97 98 0.533 Post-op complications 17 24 0.062 Tubes/drains 33 33 0.924 Relevant medications 49 49 0.969 Diet 61 65 0.386 Investigations to be done 32 25 0.05 Receiver ask questions 85 24 0.2 Student t test
Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Gender 97 98 <0.001 Post-op complications 17 24 0.062 Tubes/drains 33 33 0.924 Relevant medications 49 49 0.969 Diet 61 65 0.386 Investigations to be done 32 25 0.05 Receiver ask questions 85 24 0.2 Student t test
Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Illness severity 26 80 < 0.001 Age 6 95 < 0.001 Diagnosis 14 95 < 0.001 Past medical hx 6 23 < 0.001 Co-morbidity 13 30 < 0.001 Sx related info 11 46 < 0.001 Care plan 80 97 < 0.001 Call to do list 16 45 < 0.001 Call timeline 14 26 0.004 Situation awarenesspossible event 27 83 < 0.001 Awareness- what to do 24 82 < 0.001 Receiver summary 22 91 < 0.001 Student t test
Results Pre I-PASS (%) N=25 Post I-PASS ( %) N=25 P value Illness severity 26 80 < 0.001 Age 6 95 < 0.001 Diagnosis 14 95 < 0.001 Past medical hx 6 23 < 0.001 Co-morbidity 13 30 < 0.001 Sx related info 11 46 < 0.001 Care plan 80 97 < 0.001 Call to do list 16 45 < 0.001 Call timeline 14 26 0.004 Situation awarenesspossible event 27 83 < 0.001 Awareness- what to do 24 82 < 0.001 Receiver summary 22 91 < 0.001 Student t test
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
Limitations Hawthorne effect the resident survey was not a validated tool Did not evaluate impact on adverse events or medical errors
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
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
Improvements post study Development of a teaching video specific to our patient population
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