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Abstract
Background and objectives Despite the American College of Emergency Physicians and American Academy of Pediatrics recommendations for standardised handoffs in the emergency department (ED), few EDs have an established tool. Our aim was to improve the quality of handoffs in the ED by establishing compliance with the I-PASS handoff tool.
Methods This is a quality improvement (QI) initiative to standardise handoffs in a large academic paediatric ED. Following review of the literature and focus groups with key stakeholders, I-PASS was selected and modified to fit departmental needs. Implementation throughPlan–Do–Study–Act cycles included the development of educational materials, reminders and real-time feedback. Required use of I-PASS during designated team sign-out began in June 2016. Compliance with the handoff tool and handoff deficiencies was measured through observations by faculty trained in I-PASS. As a balancing measure, time to complete handoff was monitored and compared with preintervention data.
Results Compliance with I-PASS reached 80% within 6 months, 100% within 7 months and sustained at 100% during the remainder of the study period. The average percent of omissions of crucial information per handoff declined to 8.3%, which was a 53% decrease. Average percentage of tangential information and miscommunications per handoff did not show a decline. The average handoff took 20 min, which did not differ from the preintervention time. Survey results demonstrated a perceived improvement in patient safety through closed-loop communication, clear action lists and contingency planning and proper patient acuity identification.
Conclusions I-PASS is applicable in the ED and can be successfully implemented through QI methodology contributing to an overall culture of safety.
- quality improvement
- hand-off
- emergency department
- communication
- patient safety
Data availability statement
All data relevant to the study are included int he article or uploaded as supplemental information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
All data relevant to the study are included int he article or uploaded as supplemental information.
Footnotes
Contributors MSC conceptualised and designed the project, developed educational materials, carried out analyses, drafted the initial manuscript and reviewed and revised the manuscript. CD, KA and MR contributed to conceptualisation and design of the project, collected data and reviewed and revised the manuscript. BP contributed to conceptualisation and design of the project, provided quality improvement expertise and feedback, developed the data collection tool and reviewed and revised the manuscript. JS contributed to project design, reviewed data and revised the manuscript for important intellectual content. KL-W conceptualised and designed the project, developed educational materials, collected data, carried our analyses and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement statement Given that this was a quality improvement project to improve patient handoffs among physicians, patients and the public were not involved in the design, conduct, reporting or dissemination of our research.
Provenance and peer review Not commissioned; externally peer reviewed.