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Improving handoff with the implementation of I-PASS at a tertiary oncology hospital

BACKGROUND: Lack of consistent and standardised handoffs is a leading cause of patient harm. With increased census in our hospital medicine (HM) service, failure to handoff using a standardised method has the potential to cause significant patient harm. We used a quality improvement methodology to s...

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Autores principales: Franco Vega, Maria C, Ait Aiss, Mohamed, Smith, Maura, George, Marina, Day, Lakeisha, Mbadugha, Anayo, Niangar, Zalie, Bodurka, Diane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565279/
https://www.ncbi.nlm.nih.gov/pubmed/37802542
http://dx.doi.org/10.1136/bmjoq-2023-002481
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author Franco Vega, Maria C
Ait Aiss, Mohamed
Smith, Maura
George, Marina
Day, Lakeisha
Mbadugha, Anayo
Niangar, Zalie
Bodurka, Diane
author_facet Franco Vega, Maria C
Ait Aiss, Mohamed
Smith, Maura
George, Marina
Day, Lakeisha
Mbadugha, Anayo
Niangar, Zalie
Bodurka, Diane
author_sort Franco Vega, Maria C
collection PubMed
description BACKGROUND: Lack of consistent and standardised handoffs is a leading cause of patient harm. With increased census in our hospital medicine (HM) service, failure to handoff using a standardised method has the potential to cause significant patient harm. We used a quality improvement methodology to standardise an existing and validated handoff tool within our HM team to improve handoff communication among providers and improve patient safety. METHODS: A quality improvement team was charged with studying handoff communication among HM teams and between day and night shift providers at a tertiary oncology hospital. Multiple plan-do-study-act cycles were conducted, and process flow maps, root cause analysis and an affinity diagram were developed based on feedback from the HM team. The quality improvement team developed a plan to implement I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency plan, and Synthesis by receiver) as the standardised handoff tool to be used among the providers in HM at the end of shift and for handoff to the nocturnal covering service. Rates of I-PASS use were collected before and after several educational interventions to encourage use of I-PASS and were displayed in a control chart. After the I-PASS interventions, HM providers were surveyed twice to evaluate the secondary outcomes: the tool’s impact on workflow, perceptions of patient safety, ease of use and satisfaction with I-PASS. Survey results were compared using Fisher exact tests. RESULTS: The HM team’s rate of use of I-PASS handoffs increased from 23% to 72%, an improvement of 68%. By the end of the quality improvement project, I-PASS use had increased to 90%. No significant differences were detected in the reported duration of handoffs after I-PASS implementation (on average <5 min per patient, p=0.205). Provider perceptions of handoff quality, efficiency, communication errors and the I-PASS tool’s effectiveness were satisfactory. CONCLUSION: We used a quality improvement methodology to encourage the HM team’s adoption of a validated handoff tool. Adherence to the standardised handoff tool significantly improved workflows and facilitated communication between the day and night shift teams.
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spelling pubmed-105652792023-10-12 Improving handoff with the implementation of I-PASS at a tertiary oncology hospital Franco Vega, Maria C Ait Aiss, Mohamed Smith, Maura George, Marina Day, Lakeisha Mbadugha, Anayo Niangar, Zalie Bodurka, Diane BMJ Open Qual Quality Improvement Report BACKGROUND: Lack of consistent and standardised handoffs is a leading cause of patient harm. With increased census in our hospital medicine (HM) service, failure to handoff using a standardised method has the potential to cause significant patient harm. We used a quality improvement methodology to standardise an existing and validated handoff tool within our HM team to improve handoff communication among providers and improve patient safety. METHODS: A quality improvement team was charged with studying handoff communication among HM teams and between day and night shift providers at a tertiary oncology hospital. Multiple plan-do-study-act cycles were conducted, and process flow maps, root cause analysis and an affinity diagram were developed based on feedback from the HM team. The quality improvement team developed a plan to implement I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency plan, and Synthesis by receiver) as the standardised handoff tool to be used among the providers in HM at the end of shift and for handoff to the nocturnal covering service. Rates of I-PASS use were collected before and after several educational interventions to encourage use of I-PASS and were displayed in a control chart. After the I-PASS interventions, HM providers were surveyed twice to evaluate the secondary outcomes: the tool’s impact on workflow, perceptions of patient safety, ease of use and satisfaction with I-PASS. Survey results were compared using Fisher exact tests. RESULTS: The HM team’s rate of use of I-PASS handoffs increased from 23% to 72%, an improvement of 68%. By the end of the quality improvement project, I-PASS use had increased to 90%. No significant differences were detected in the reported duration of handoffs after I-PASS implementation (on average <5 min per patient, p=0.205). Provider perceptions of handoff quality, efficiency, communication errors and the I-PASS tool’s effectiveness were satisfactory. CONCLUSION: We used a quality improvement methodology to encourage the HM team’s adoption of a validated handoff tool. Adherence to the standardised handoff tool significantly improved workflows and facilitated communication between the day and night shift teams. BMJ Publishing Group 2023-10-06 /pmc/articles/PMC10565279/ /pubmed/37802542 http://dx.doi.org/10.1136/bmjoq-2023-002481 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/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/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Franco Vega, Maria C
Ait Aiss, Mohamed
Smith, Maura
George, Marina
Day, Lakeisha
Mbadugha, Anayo
Niangar, Zalie
Bodurka, Diane
Improving handoff with the implementation of I-PASS at a tertiary oncology hospital
title Improving handoff with the implementation of I-PASS at a tertiary oncology hospital
title_full Improving handoff with the implementation of I-PASS at a tertiary oncology hospital
title_fullStr Improving handoff with the implementation of I-PASS at a tertiary oncology hospital
title_full_unstemmed Improving handoff with the implementation of I-PASS at a tertiary oncology hospital
title_short Improving handoff with the implementation of I-PASS at a tertiary oncology hospital
title_sort improving handoff with the implementation of i-pass at a tertiary oncology hospital
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565279/
https://www.ncbi.nlm.nih.gov/pubmed/37802542
http://dx.doi.org/10.1136/bmjoq-2023-002481
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