About 15 years ago, pediatricians Christopher Landrigan and Amy Starmer observed a weak link in hospital care: Medical residents were rigorously trained to take patient histories with standardized templates and to present cases in a structured format during daily rounds, yet such structured communication was largely absent during shift changes, when patients' care was handed off to new providers.
- By NANCY FLIESLER | Boston Children's
Patients admitted to the hospital typically have multiple provider teams caring for them, with information handoffs occurring frequently during their stay. These handoffs "are a common source of vulnerability for patients," said Landrigan, now chief of the Division of General Pediatrics at Boston Children's Hospital.
Miscommunication contributes to about two-thirds of serious adverse events in hospitals, according to the Joint Commission, a leading health care quality assessment organization. And handoffs are especially prone to communication lapses. Providers finishing a shift may be tired and rushed and more apt to omit key information important to the patient's care.
Wanting to improve this process, Starmer and Landrigan created the I-PASS handoff program, which consists of a package of communication and training tools that prompt providers to pass on crucial information - both verbally and in writing - in a reliable, structured fashion.
In a study published in the Journal of Hospital Medicine in November, the team at Boston Children's and Harvard Medical School put I-PASS to the test in a diverse group of hospitals. Results were striking: Over a three-year period, adverse medical events were reduced by nearly half.
Capturing critical information
I-PASS revolves around a simple mnemonic that specifies information to be exchanged during handoffs:
I: Illness severity
P: Patient summary
A: Action list
S: Situational awareness/contingency planning
S: Synthesis of the information by the incoming provider
"We wanted to add structure to what was an unstructured and sometimes haphazard process," explained Starmer, HMS assistant professor of pediatrics and associate medical director of quality at Boston Children's.
