![]() Details of the curriculum design and implementation are described in another article. The UW-IPASS handoff curriculum was developed by a resident-led team as part of a quality improvement project to address handoff communication inadequacy at a multisite academic institution. 10 Moreover, resident work hour restrictions have led to more frequent handoff communications and thus could increase the occasions for inaccuracies or omissions. Covering residents may have only fragmented knowledge of patients and therefore rely heavily on clear, concise, and directed handoff from the previous clinician. This commonly occurs overnight when staff support and direct senior supervision may be diminished. 5 At teaching hospitals, resident physicians often “cross cover,” serving as temporary clinicians for patients. Standardization and improvement of handoff practices are particularly crucial in an academic environment. 4 - 6 Despite this, to our knowledge, few attempts have been made to standardize handoff communication in an evidence-based manner. 4 The Joint Commission and the Accreditation Council for Graduate Medical Education have identified handoff communication as a key target for national quality improvement and patient safety efforts. 2, 3 Handoffs during transitions of care represent a significant proportion of interclinician communication and are particularly susceptible to error. Trial Registration Identifier: ISRCTN14209509Įvery year, clinician miscommunication contributes to approximately one-third of serious inpatient medical errors, 1 resulting in an estimated 250 000 preventable deaths annually in US hospitals. IPASS-based curricula represent an important step forward in communication standardization efforts and may help reduce communication errors and omissions. Overall, UW-IPASS was not associated with any changes in intensive care unit length of stay, duration of mechanical ventilation, or the number of reintubations.Ĭonclusions and Relevance The UW-IPASS standardized handoff curriculum was perceived to improve intensive care provider preparedness and workflow. Early morning order entry decreased from 106 per 100 patient-days in the control phase to 78 per 100 patient-days in the intervention period (−28 orders 95% CI, −55 to −4 P = .04). Compared with the control phase, the perceived duration of handoffs among clinicians using UW-IPASS was unchanged (+5.5 minutes 95% CI, 0.34-9.39 P = .30). During the control period, clinicians reported being unprepared for their shift because of a poor-quality handoff in 35 of 343 handoffs (10.2%), while UW-IPASS–period residents reported being unprepared in 53 of 740 handoffs (7.2%) (odds ratio, 0.19 95% CI, 0.03-0.74 P = .03). Results A total of 63 residents and advance practice clinicians, 13 fellows, and 30 attending physicians participated in the study. Mixed-effects logistic regression was used to compute odds ratios and confidence intervals with adjustment for location, time period, and clinician. Patient days of mechanical ventilation, intensive care unit length of stay, reintubations within 24 hours, and order workflow patterns were also analyzed. Main Outcomes and Measures The primary aim was to assess the effect of the UW-IPASS handoff curriculum on perceived adequacy of interclinician communication. Participants included residents, fellows, advance-practice clinicians, and attending physicians (n = 106 clinicians, with 1488 handoff events over 8 months) and data were collected from daily text message–based surveys and patient medical records.Įxposures The UW-IPASS standardized handoff curriculum Objective To determine the effect of a standardized handoff curriculum, UW-IPASS, on interclinician communication and patient outcomes.ĭesign, Setting, and Participants This cluster randomized stepped-wedge randomized clinical trial was conducted from October 2015 to May 2016 at 8 medical and surgical intensive care units at 2 hospital systems within an academic tertiary referral center. ![]() Efforts to standardize handoff communication may reduce errors and improve patient safety. ![]() Importance Clinician miscommunication contributes to an estimated 250 000 deaths in US hospitals per year. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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