Optimal handover features and corresponding MGH implementation tactics
| Achieving optimal handovers | MGH implementation tactics |
|---|---|
| Senior leadership support | All hospital administrative and clinical leadership engaged, and actively and publicly supported implementation |
| Formal education and training for all care providers | Function and venue-specific, multimodality training programme developed for all direct caregivers, departments and units |
| Make evidence-based case for handover improvement | All training sessions and presentations begin with discussion of current handover deficiencies and their consequences |
| Handover recognised as transfer of patient information and responsibility | Training programme explicitly discusses handovers as transfer of patient responsibility, not just information |
| Cultural expectation of concise, complete, accurate handovers | Strategic goal is to advance MGH safety culture, creating an expectation for optimal, structured handovers |
| Complete critical diagnostic (test results) and treatment activities before handovers; adequate handover time, quiet space, ‘sterile cockpit’ with limited interruptions | Training programme emphasises handover context—critical test results and other tasks completed, appropriate time and space, limited interruptions |
| Concomitant team training, such as TeamSTEPPS and Crew Resource Management | Training programme includes introduction to TeamSTEPPS |
| Standardised content, structure, sequence (facilitate with mnemonics) | Standardised I-PASS structure is simple, intuitive, easy to remember and use |
| Adapt to local workflows | Basic I-PASS handover structure and content adapted to specific services, units and workflows; suggestions elicited from front-line staff, including residents |
| Direct, interactive, face-to-face communication with opportunity for questions | Training programme emphasises in-person verbal handovers with interactive dialogue whenever possible |
| Written or electronic handover document supplements verbal communication; integration with IT systems (including templates and prompts); facilitates but does not replace face-to-face communication | I-PASS implementation overlapped with installation of new EHR, which was modified to include I-PASS formatted handover templates with some autopopulation functionality |
| Explicit contingency planning for active and anticipated problems | Situational awareness and contingency planning are the fourth element of an I-PASS handover |
| Verification—‘readback’ or ‘checkback’ | Synthesis (read back and interactive discussion) is fifth element of I-PASS handover |
| Observations | Observations strongly encouraged for each department; results recorded, tabulated; transparent feedback provided |
| Assess outcomes | Kirkpatrick51 training effectiveness levels 1–3 evaluated, level 4 pending |
MGH, Massachusetts General Hospital.