Background There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes’ effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs).
Methods Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation.
Results We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5–97.4) vs intervention 60.4 (33.2–109.9), p=0.99, risk ratio: 1.0 (0.74–1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6–41.8) vs intervention 34.7 min (26.5–42.1); difference 1.43 min (95% CI −2.63 to 5.49, p=0.49)). The providers’ perception of improved communication did not change.
Conclusions After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs’ frequency or the perception of enhanced communication.
Trial registration number NCT03924570
- quality improvement
- adverse events
- epidemiology and detection
- critical care
Data availability statement
Data are available in a public, open-access repository: https://osf.io/gn4qu/?view_only=4472676a10a541e0be2f87f0971e7064.
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Contributors FJB, EGE, LML and JCV conceived the original idea and study design. FJB and EGE contributed to the design and implementation of the research. RBP, NDM, MP, RG, APR, DV, SA, LG, SL, JO and GR contributed to the implementation of the research. FJB, EGE, ISA, LG and RR contributed to the analysis and interpretation of the results and to the writing of the manuscript. All authors discussed the results and commented on the manuscript.
Funding Salud Investiga ‘Dr Abraam Sonis’ grant, category Multicentric Study, funded by the National Ministry of Health, through the Directorate of Research for Health, Argentine.
Disclaimer The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.
Competing interests FJB, LML, MP, GR, NDM, RBP and ISA report grants from the Ministry of Health of the Nation, through the Directorate of Research for Health, Argentine, during the conduct of the study.
Provenance and peer review Not commissioned; externally peer reviewed.
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