title: Changes in Efficiency and Safety Culture After Integration of an I-PASS-Supported Handoff Process.
abstract: OBJECTIVE
  Recent publications have shown improved outcomes associated with resident-to-resident handoff processes. However, the implementation of similar handoff processes for patients moving between units and teams with expansive responsibilities presents unique challenges. We sought to determine the impact of a multidisciplinary standardized handoff process on efficiency, safety culture, and satisfaction.
  
  
  METHODS
  A prospective improvement initiative to standardize handoffs during patient transitions from the cardiovascular ICU to the acute care unit was implemented in a university-affiliated children's hospital.
  
  
  RESULTS
  Time between verbal handoff and patient transfer decreased from baseline (397 ± 167 minutes) to the postintervention period (24 ± 21 minutes) (P < .01). Percentage positive scores for the handoff/transitions domain of a national culture of safety survey improved (39.8% vs 15.2% and 38.8% vs 19.6%; P = .005 and 0.03, respectively). Provider satisfaction improved related to the information conveyed (34% to 41%; P = .03), time to transfer (5% to 34%; P < .01), and overall experience (3% to 24%; P < .01). Family satisfaction improved for several questions, including: "satisfaction with the information conveyed" (42% to 70%; P = .02), "opportunities to ask questions" (46% to 74%; P < .01), and "Acute Care team's knowledgeabout my child's issues" (50% to 73%; P = .04). No differences in rates of readmission, rapid response team calls, or mortality were observed.
  
  
  CONCLUSIONS
  Implementation of a multidisciplinary I-PASS-supported handoff process for patients transferring from the cardiovascular ICU to the acute care unit resulted in improved transfer efficiency, safety culture scores, and satisfaction of providers and families.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California;
authors.forename: Shreya
authors.initials: S
authors.lastname: Sheth
authors.affiliation: Divisions of Pediatric Cardiology, and.
authors.forename: Elisa
authors.initials: E
authors.lastname: McCarthy
authors.affiliation: Divisions of Pediatric Cardiology, and.
authors.forename: Alaina K
authors.initials: AK
authors.lastname: Kipps
authors.affiliation: Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wood
authors.affiliation: Divisions of Pediatric Cardiology, and.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.affiliation: Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: Divisions of Pediatric Cardiology, and Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California drewshin@stanford.edu.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D016507:Cardiology Service, Hospital / Q000458:organization & administration / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D017598:Efficiency, Organizational / Q000592:standards*; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006785:Hospitals, University / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration / Q000592:standards*; D007588:Job Satisfaction; D008297:Male; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000458:organization & administration / Q000592:standards; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D013997:Time Factors