Patient Handoff Success Reaches More Hospitals

Marcia Frellick

April 11, 2018

ORLANDO — An information-handoff technique, already shown to be effective in pediatric academic hospitals, has proven its effectiveness in a new study of 32 hospitals that vary widely in setting, size, and patient population.

The technique, known as I-PASS — a mnemonic for illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver — is designed to improve hospital communication and reduce errors.

This approach stands out for several reasons, including its performance over many years and levels of research, said Amy Starmer, MD, from Boston Children's Hospital and Harvard Medical School, who has led the research on I-PASS for nearly a decade.

"While there are other approaches to handoff improvement, I don't think there's anything out there that has this rigor and data behind it," she told Medscape Medical News.

Her team's abstract was chosen for presentation at the annual top-research plenary here at the Society of Hospital Medicine 2018 Annual Meeting.

The protocol has been tested in many settings. It effectively lowered medical errors at two Boston Children's Hospital inpatient units and in pediatric residency programs at nine hospitals throughout the United States, as previously reported by Medscape Medical News.

For their latest work, Starmer and her colleagues implemented I-PASS in 32 hospitals. In the 20 academic and 12 community hospitals, 13 internal medicine specialties, 12 pediatric specialties, and 7 other specialties were involved.

Mentorship Teams Key to Success

The researchers paired each site with a mentorship team of I-PASS experts who made site visits and provided monthly coaching. The mentorship teams were made up of two physicians with I-PASS experience, a central program coordinator, and data analyst.

These teams are one of the key reasons I-PASS works, Starmer explained. They provide feedback and data regularly so that people know how successful the implementation is.

The researchers assessed handoffs before and after I-PASS implementation.

The 3799 verbal handoffs analyzed involved 10 observations per site per month, and the 1698 frontline clinician reports of adverse events involved four reports per site per month. In addition, 1620 printed handoff and written handoff documents were analyzed.

Table. Percent of Handoff Communications Considered Very Good or Excellent

Skill Baseline, % 12 Months After
Implementation, %
P Value
Patient synthesis summary 38.7 80.9 .05
Contingency plans 28.9 77.8 .05
Understanding by receiver 30.8 84.7 .05
Patient summary 29.1 78.1 .05
Contingency plans 24.1 72.6 .05


Over the 12-month study period, the number of major harm events dropped a significant 47.1% — from 1.7 to 0.9 events per person-year (< .05). And the number of handoff-related minor events dropped 46.9% — from 17.5 to 9.3 per person-year (< .001).

Part of the reason for the large improvements is the fact that, before I-PASS implementation, most of the sites didn't have formalized plans for improving handoffs, Starmer explained.

Future studies will need to see whether this perception actually correlated with a real improvement in clinical outcomes.

The number and variety of institutions that saw improved communication are impressive, said Margaret Fang, MD, from the University of California, San Francisco.

The UCSF Benioff Children's Hospital is an I-PASS mentor site, she noted, but the approach is used only on the pediatric service, not on the adult medicine service.

"Future studies will need to see whether this perception actually correlates with a real improvement in clinical outcomes," Fang told Medscape Medical News.

The study only looked at residents, and it is unclear whether different providers would get the same results, the researchers acknowledge. However, the work coincides with a push by regulatory bodies for residency programs to show that they are approaching handoff communication in a structured way, Starmer said.

The team is currently looking at handoffs between different environments, such as those from inpatient to outpatient or primary care to emergency department settings.

Starmer cofounded, serves as a board member, holds equity interest in, and serves as a consultant for the I-PASS Institute, a company designed to assist institutions with the implementation of the I-PASS Handoff Program, and reports receiving grant funding from the Agency for Healthcare Research and Quality and consulting fees for helping various institutions implement I-PASS. Fang has disclosed no relevant financial relationships.

Society of Hospital Medicine (HM) 2018 Annual Meeting. Presented April 10, 2018.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick


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