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Large-scale implementation of the I-PASS handover system at an academic medical centre
  1. David M Shahian1,2,
  2. Kayla McEachern3,
  3. Laura Rossi3,
  4. Roger Gino Chisari4,
  5. Elizabeth Mort5,6
  1. 1Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA
  4. 4Norman Knight Center for Clinical and Professional Development, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Center for Quality and Safety and Department of Medicine, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA
  6. 6 Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr David M Shahian, Massachusetts General Hospital and Massachusetts General Physicians Organization, Center for Quality and Safety and Department of Surgery, Boston, MA 02114, USA; dshahian{at}partners.org

Abstract

Background Healthcare has become increasingly complex and care delivery models have changed dramatically (eg, team-based care, duty-hour restrictions). However, approaches to critical communications among providers have not evolved to meet these new challenges. Evidence from safety culture surveys, academic studies and malpractice claims suggests that healthcare handover quality is problematic, leading to preventable errors and adverse outcomes. To address this concern, from 2013 to 2016 Massachusetts General Hospital completed phase I of a multifaceted programme to implement standardised, structured handovers across all departments, units and direct care providers.

Methods A multidisciplinary Handovers Committee selected the I-PASS handover system. Phase I implementation focused on large-scale training and shift-to-shift handovers. Important features included administrative and clinical leadership support; EHR templates for I-PASS; hospital handover policy revision; varied educational modalities, venues and durations; concomitant TeamSTEPPS training; unit-level I-PASS champions; handover observations; and solicitation of caregiver feedback and suggestions.

Results More than 6000 doctors, nurses and therapists have been trained. Trended observation scores demonstrate progressive but non-uniform adoption of I-PASS, with significant improvements in the correct sequencing and percentage of I-PASS elements included in handovers. Adoption of Synthesis (readback) has been challenging, with lower scores.

Conclusions Comprehensive I-PASS implementation in a large academic medical centre necessitated major cultural change. I-PASS education is straightforward, whereas assuring consistent and sustained adoption across all services is more challenging, requiring adaptation of the basic I-PASS structure to local needs and workflows. EHR I-PASS templates facilitated caregiver acceptance. Initial phase I results are encouraging and the lessons learned should be helpful to other programmes planning handover initiatives. Phase II is ongoing, focusing on more uniform and consistent adoption, spread and sustainability.

  • Communication
  • Hand-off
  • Human factors
  • Patient safety
  • Transitions in care

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Footnotes

  • Correction notice This article has been corrected since it first published Online First. The abstract has been added.

  • Contributors DMS, KMcE, LR, RGC, EM conceived and led the I-PASS initiative, collected and analysed data, and made critical manuscript revisions; DMS and RGC provided graphics; DMS drafted the original manuscript and revision, submitted the original manuscript and revision; and is responsible for the overall content.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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