RT Journal Article
SR Electronic
T1 Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 782
OP 791
DO 10.1136/bmjqs-2020-012370
VO 30
IS 10
A1 Facundo Jorro-Barón
A1 Inés Suarez-Anzorena
A1 Rodrigo Burgos-Pratx
A1 Noelia De Maio
A1 Matías Penazzi
A1 Ana Paula Rodriguez
A1 Gisela Rodriguez
A1 Daniel Velardez
A1 Luz Gibbons
A1 Silvina Ábalos
A1 Silvina Lardone
A1 Rosario Gallagher
A1 Joaquín Olivieri
A1 Rocío Rodriguez
A1 Juan Carlos Vassallo
A1 Luis Martín Landry
A1 Ezequiel García-Elorrio
YR 2021
UL http://qualitysafety.bmj.com/content/30/10/782.abstract
AB 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 Data are available in a public, open-access repository: https://osf.io/gn4qu/?view_only=4472676a10a541e0be2f87f0971e7064.