Significant reductions in medical errors and preventable adverse events are possible when healthcare providers standardize the way patients are handed off from one physician to the next during shift changes, according to a new study.
Medical-error rates dropped 23% and adverse events decreased by 30% among nine pediatric hospitals that all implemented one consistent handoff process for medical residents.
Between January 2011 and May 2013, the inpatient units of nine pediatric residency training programs in the U.S. and Canada began implementing a bundle of handoff interventions called I-PASS. The term is a mnemonic for the communications that are vital during a handoff: illness severity; patient summary; action list; situational awareness and contingency planning; and synthesis by receiver.
The I-PASS program was created by researchers from Boston Children's Hospital in 2009, and had previously been used only at its 395-bed hospital. The program incorporates a series of best practices on handoffs from the existing literature.
“We recognized that it would take a great deal of work to make the handoff program a sustainable system and encourage its adoption across hospitals,” explained Dr. Amy Starmer, lead author of the new study funded by HHS and published Nov. 6 in the New England Journal of Medicine.
Each pediatric institution was required to hold mandatory education workshops and simulations, institute a process and culture-change campaign, and use a standardized oral and written handoff process that was either built into the organization's electronic health record system or its word-processing programs. Once the program was in place, medical-record and post-shift surveys were conducted and reviewed daily. The hospitals were evaluated for six months.
Researchers reviewed 10,740 patient admissions (5,516 pre-intervention and 5,224 post-intervention) and tracked the handoffs of 875 residents.
The overall rate of medical errors dropped from 24.5 per 100 admissions to 18.8 per 100 admissions. Preventable adverse events decreased from 4.7 per 100 admissions to 3.3 per 100 admissions. The program also significantly reduced the number of near misses, which dropped from 19.7 per 100 admissions to 15.5 per 100 admissions.
The researchers additionally concluded that the revised handoff process was not more time consuming. Residents spent 2.4 minutes on handoff sessions before adopting the program and 2.5 minutes after its adoption.
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