Jude institutional review board and supported by clinical leaders at all levels. Registered nurses who work in inpatient settings conducted bedside reports, and the imaging/procedures handoffs were conducted among inpatient nurses communicating with diagnostic technologists or ambulatory nurses in the procedures department. Oncology fellows and hospitalists primarily conducted physician signout. We selected 3 handoff contexts for this QI initiative: evening shift to shift physician signout, morning and evening inpatient nursing bedside report, and handoffs when admitted patients were temporarily transferred to the diagnostic imaging or procedures departments. These factors amplify the need for frequent, effective handoff communications to provide and coordinate the delivery of complex care for prolonged periods. A single patient may be cared for in the inpatient and outpatient settings over several months to years, with ongoing consultations with specialists as needed. Patient care teams are often large and multidisciplinary. Once accepted, patients receive nearly all their care at St. Most patients require ongoing treatment in inpatient and outpatient settings for complex medical diagnoses. Jude sees ≈7,500 patients in ≈3,500 inpatient admissions and ≈75,000 outpatient visits per year. Jude) is an 80-bed pediatric hospital with integrated outpatient clinics offering subspecialty and surgical services for children with cancer, blood disorders, and other catastrophic diseases. For each handoff context involved, the initial goal was that within 6 months of implementing I-PASS, 75% of handoffs would use all 5 I-PASS components. 12- 15 Herein, we describe our quality improvement (QI) initiative to adapt, implement, and sustain I-PASS for handoff communication across various contexts at a pediatric teaching hospital. We selected the I-PASS program because of the strong evidence that its use reduces errors 9 and the emerging evidence that I-PASS can be adapted broadly across handoff contexts. In consideration of our hospital’s patient safety events, patient safety culture survey results, and focus group feedback, standardizing patient handoffs was identified as an institutional improvement priority. Central to the I-PASS program is its mnemonic, which represents 5 components of quality patient handoff: illness severity (I), patient summary (P), action list (A), situational awareness and contingency plans (S), and synthesis by the receiver (S). Starmer et al 10 described the I-PASS program curriculum that used successful tactics to address cultures that are resistant to change. I-PASS aims to help clinicians develop a shared mental model of each patient so that every clinician involved in the patient’s care can make decisions aligned with overall goals. I-PASS is a comprehensive handoff program that trains clinicians to exchange and synthesize relevant patient information concisely. Their study used rigorous methodology to demonstrate that the use of a structured handoff communication program, I-PASS, led to a 23% reduction in medical errors and a 30% reduction in preventable adverse events (AEs) among residents physicians at 9 pediatric hospitals. 8 More recently, a landmark paper by Starmer et al 9 reported improvements in patient safety through handoff standardization. Earlier studies showed that training clinicians to provide structured patient handoffs increased clinician comfort and patient information retention. Structured patient handoff processes can improve the fidelity of communication. Effective handoff communication skills need to be systematically taught, but few clinicians receive formal handoff education during training. 6 Clinicians across all disciplines regularly participate in some form of patient handoff or transition of care. Studies in teaching hospitals have documented 4,000 patient handoffs per day. 5 Approximately half of these communication failures occur during patient handoffs, which are pervasive in current healthcare systems. 3, 4 The Joint Commission reported communication failures as the root cause of most sentinel events. While controversy exists regarding the number of patient deaths that result from medical errors annually, 1, 2 experts agree this is a significant problem in healthcare.
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