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Patient Safety Tip of the Week

September 29, 2020

ISHAPED for Nursing Handoffs



We’ve covered just about every type of handoff in healthcare in our previous columns (see the full list below) and touched upon almost every one of the mnemonics for those handoffs. But one we have never discussed is ISHAPED.


ISHAPED stands for Introduction, Story, History, Assessment, Plan, Error-Prevention, and Dialogue. It is a format that has been used in shift-to-shift nursing handoffs at the bedside. At Seattle Children’s Hospital shift-to-shift handoffs were not considered to be problematic but anecdotal concerns had been raised regarding handoffs between departments (intensive care to acute care, emergency department to acute care, etc.). A prior systematic review (Ong 2011) had also found that exposure of handoffs at patient transfers presented challenges that are not experienced in inter-shift handoffs. So, clinicians and researchers at Seattle Children’s Hospital (Stimpson 2020) implemented a modified ISHAPED (m-ISHAPED) tool to align the content shared and the expectations for interdepartmental handoffs. Their quality improvement team and relevant stakeholders studied multiple handoff tools and ultimately chose ISHAPED as the one to use for interdepartmental handoffs.


The original ISHAPED tool was developed by the Inova Health System (Friesen 2013). The original ISHAPED tool from Inova Health is available on the IHI (Institute for Healthcare Improvement) website. Because the original tool was intended for shift-to-shift bedside handoffs, the Seattle Children’s team modified it for interdepartmental handoffs and pediatric patients. The resultant m-ISHAPE Form is available on the web:


Their implementation plan included 4 key elements:

  1. Creation of a job aid, intended to be used as a reference at the time of handoff
  2. Creation of an education plan that leveraged preexisting annual nurse education time. The education consisted of a short didactic section, a video demonstrating the process in action, and time for the nurses to practice using it with short scenarios;
  3. Creation of a superuser support plan for the first week of go-live. Nurses who were involved in the project received additional training to support the new practice change;
  4. K-card audit and coaching, which included realtime coaching, and collection of feedback from the nurses.


They then implemented the new interdepartmental handoff process and the m-ISHAPED tool across the ED, acute care units (medical, surgical, and oncology), ICUs (pediatric,

cardiac, and neonatal), rehabilitation unit, postanesthesia care unit (PACU), inpatient psychiatric unit, and ambulatory infusion area.


Audits revealed the process was widely adhered to and the tool used correctly 82.6% of the time. Handoff failures were identified as having incorrect or missing information or resulting in a delay, omission, or delivery of inappropriate care. The rate of handoff failures fell from 6.84 per 100 patient days pre-implementation to 1.57 per 100 patient days post-implementation (P < .001). Nurse satisfaction with the handoff process improved from 81.1% pre-implementation to 90.6% post-implementation (P < .001).


The authors note that some nursing units and departments have begun using the tool for shift-to-shift handoffs as well.


We note that the tool conveys a tremendous amount of information. Hence, some of the important considerations for any handoff apply, such as allowing ample time, doing the handoff in a quiet environment devoid of interruptions and distractions, and allowing the receiver to ask questions and seek clarification. Importantly, the tool emphasizes the use of “repeat-back”. When Inova originally developed ISHAPED they also identified multiple best practices for handoffs, including use of face-to-face communication, use of written documentation, and importance of read-back. They also emphasized that handoffs involve not only the transfer of information but also the unambiguous transfer of responsibility.


So go ahead and add ISHAPED as one more option to choose from when you are looking at improving your handoffs, particularly your interdepartmental handoffs.



Read about many other handoff issues (in both healthcare and other industries) in some of our previous columns:


May 15, 2007              Communication, Hearback and Other Lessons from Aviation

May 22, 2007              More on TeamSTEPPS

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     Hot Topic: Handoffs

November 18, 2008     Ticket to Ride: Checklist, Form, or Decision Scorecard?

December 2008            Another Good Paper on Handoffs”.

June 30, 2009               iSoBAR: Australian Clinical Handoffs/Handovers

April 25, 2009             Interruptions, Distractions, Inattention…Oops!

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

March 2012                 More on Perioperative Handoffs

June 2012                    I-PASS Results and Resources Now Available

August 2012               New Joint Commission Tools for Improving Handoffs

August 2012                Review of Postoperative Handoffs

January 29, 2013         A Flurry of Activity on Handoffs

December 10, 2013     Better Handoffs, Better Results

February 11, 2014       Another Perioperative Handoff Tool: SWITCH

March 2014                  The “Reverse” Perioperative Handoff: ICU to OR

September 9, 2014      The Handback

December 2014            I-PASS Passes the Test

January 6, 2015            Yet Another Handoff: The Intraoperative Handoff

March 2017                 Adding Structure to Multidisciplinary Rounds

August 22, 2017         OR to ICU Handoff Success

October 2017              Joint Commission Sentinel Event Alert on Handoffs

October 30, 2018        Interhospital Transfers

April 9, 2019               Handoffs for Every Occasion

November 2019          I-PASS Delivers Again

August 2020               New Twist on Resident Work Hours and Patient Safety



Some of our prior columns on intrahospital transports and the “Ticket to Ride” concept:






Ong MS, Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf 2011; 37(6): 274-284



Stimpson M, Carlin K, Ridling D, Implementation of the m-ISHAPED Tool for Nursing Interdepartmental Handoffs, Journal of Nursing Care Quality 2020; 35(4): 329-335



Friesen MA, Herbst A, Turner JW, Speroni KG, Robinson J. Developing a patient-centered ISHAPED handoff with patient/family and parent advisory councils. J Nurs Care Qual 2013; 28(3): 208-216



Inova Health System. ISHAPED Patient-Centered Approach to Nurse Shift Change Bedside Report. IHI (Institute for Healthcare Improvement). 2012; Accessed September 2, 2020



m-ISHAPE Form. Seattle Childrens’ Hospital.






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