In our February 14, 2012 Patient Safety Tip of the Week “Handoffs – More Than Battle of the Mnemonics” we highlighted a new standardized handoff project “I-PASS” being piloted in a collaborative project led by Boston Children’s Hospital and several pediatric organizations (Starmer 2012). The leaders of the pediatric collaborative recognized that the SBAR format does not work very well for resident-to-resident handoffs, etc. because the situations are much more complex. So, even though adoption of SBAR has been shown to reduce adverse events in hospitals, they looked at other formats. Feedback from residents involved in a pilot of one tool said that a tool/format needed to be short, easy to remember, and not have elements that overlapped each other. They also recognized that it would have to integrate with the increasing use of computerized tools for handoffs and other communication. So they came up with the I-PASS format (and note that even though it sounds like the I PASS the BATON format it is a totally different format):
I: Illness Severity
P: Patient Summary
A: Action List
S: Situation Awareness and Contingency Planning
S: Synthesis by Receiver
The final “S” emphasizes a key feature of all successful communication: it ensures that the message is fully understood by the person receiving the handoff, including asking questions then summarizing the key steps and restating the key actions/to-do steps. The Starmer article includes a nice example of use of the I-PASS format in a clinical handoff. The Starmer article also summarizes some of the key elements that make a mnemonic successful. It needs to be “catchy”, symbolic, parsimonious, utilitarian, and somehow link a visual image to a process or subject. The I-PASS mnemonic certainly accomplishes that.
But make no mistake. This project is much more than just a new format. It also involves extensive team training (based on TeamSTEPPS™), simulation and role playing, direct observation of handoffs with feedback, and generation of a printed handoff document that can be integrated with the electronic medical record.
The I-PASS Study collaborative is now ongoing at 10 pediatric institutions and they have now demonstrated a significant reduction in medical errors after implementation of the program (Boston Children’s Hospital 2012). They found a 40% reduction in medical errors in a before and after study. Amazingly, they also found significant increases in patient contact and reduced computer time after implementation. They also documented numerous improvements in elements of the handoff process.
They have now made available many of the tools used in the program on the I-PASS website. These include materials for training both residents and faculty/attendings, sample simulations and role playing exercises, tools for feedback for direct observation of handoffs, and many other great tools.
Kudos to everyone involved in this project! They have done a great job addressing one of the most problematic interactions we see in medicine. Whether or not you adopt the I-PASS format itself at your institution, you will learn an incredible amount about handoffs and communication from this project.
Read about many other handoff issues (in both healthcare and other industries) in some of our previous columns:
May 15, 2007 “ ”
May 22, 2007 “ ”
August 28, 2007 “Lessons Learned from Transportation Accidents”
December 11, 2007 “Communication…Communication…Communication”
February 26, 2008 “Nightmares….The Hospital at Night”
September 30, 2008 “ ”
November 18, 2008 “ ”
December 2008 “Another Good Paper on Handoffs”.
June 30, 2009 “ ”
April 25, 2009 “ ”
April 13, 2010 “Update on Handoffs”
July 12, 2011 “Psst! Pass it on…How a kid’s game can mold good handoffs”
July 19, 2011 “Communication Across Professions”
November 2011 “Restricted Housestaff Work Hours and Patient Handoffs”
December 2011 “AORN Perioperative Handoff Toolkit”
February 14, 2012 “Handoffs – More Than Battle of the Mnemonics”
Starmer AJ, Spector ND, Srivastava R, et al. and the I-PASS Study Group. I-PASS, a Mnemonic to Standardize Verbal Handoffs.
Pediatrics 2012; 129(2): 201 -204
Boston Children’s Hospital. I-PASS: Standardizing patient "handoffs" to reduce medical errors. News Release April 29, 2012
I-PASS Study website.