Table 1

Timeline of interventions

PDSA cycleDateProcess change
Cycle 1November 2015Education sessions for NICU fellows, NNPs and PAs on NICU I-PASS curriculum.
Implementation of the new electronic handoff tool.
Education on avoidable and unavoidable interruptions given to nurses and attendings.
New designated space for handoffs.
’Stop, handoff in progress’ sign on the door placed during handoff.
Cycle 2December 2015Recruitment of nurse champion.
Reducing avoidable interruptions added as a goal to Lean Daily Management QI Board.
Reminder of medical team handoff times shared with attendings and nurses.
February 2016NICU I-PASS bulletin board displaying monthly data collection calendar and graphs with number and source of interruptions.
Feedback given to nurses by nurse champion during huddles.
Feedback to attendings given during fellow conferences.
Cycle 3June 2016NICU moved to a new critical care tower.
Data collection reminder calendar placed in the workroom.
June 2017New smaller space for handoffs selected away from unit entrance, patient care areas and workrooms with one computer.
Handoff limited to one team signing out at a time.
  • NICU, neonatal intensive care unit; NNPs, neonatal nurse practitioners; PAs, physician assistants; PDSA, plan–do–study–act.