title: Physician Transition of Care: Benefits of I-PASS and an Electronic Handoff System in a Community Pediatric Residency Program.
abstract: Miscommunication is a leading cause of adverse events in hospitals. Optimizing the handoff process improves communication and patient safety. We sought to assess how the components of I-PASS (a mnemonic for illness severity, patient summary, action list, situational awareness with contingency planning, and synthesis by the receiver), a standardized handoff bundle, improved the quality of handoffs in a pediatric residency program based in a community hospital.
  
  
  
  Pediatric residents in a university-affiliated community teaching hospital were observed on the pediatric inpatient floor and in the newborn nursery. One hundred resident handoffs per setting were analyzed in 3 phases, with a total of 600 handoffs assessed. Phase 1 comprised preintervention handoffs before I-PASS; phase 2, initiating I-PASS mnemonic and educational session; and phase 3, implementing a handoff tool, electronic physician handoff (EPH), into the electronic medical record. One attending physician at each setting assessed the handoff process using an 11-item survey. A resident satisfaction survey assessed the resident's experience after phase 3.
  
  
  
  Comparing phase 1 with phase 2, there was improved situational awareness with contingency planning (nursery: 12% to 83%, P = .001; floor: 21% to 84%, P = .001). Incidence of tangential conversation decreased in both settings (nursery: 100% to 23%, P = .001; floor: 84% to 11%, P = .001). Comparing phase 2 with phase 3, there was improvement in identification of illness severity (nursery: 62% to 99%, P = .001; floor: 41% to 64%, P = .001) and fewer omissions of important information (nursery: 14% to 0%, P = .001; floor: 33% to 17%, P = .007). A total of 93% of residents found the new EPH system to be beneficial.
  
  
  
  Specific components of a standardized handoff system, including a mnemonic, an educational intervention, and an EPH, improved the clarity and organization of key information in handoff.
authors.affiliation: New York Methodist Hospital, Brooklyn, NY. Electronic address: jkw02005@gmail.com.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Walia
authors.affiliation: New York Methodist Hospital, Brooklyn, NY.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Qayumi
authors.affiliation: New York Methodist Hospital, Brooklyn, NY.
authors.forename: Nayaab
authors.initials: N
authors.lastname: Khawar
authors.affiliation: New York Methodist Hospital, Brooklyn, NY.
authors.forename: Beata
authors.initials: B
authors.lastname: Dygulska
authors.affiliation: New York Methodist Hospital, Brooklyn, NY.
authors.forename: Ilya
authors.initials: I
authors.lastname: Bialik
authors.affiliation: New York Methodist Hospital, Brooklyn, NY.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Salafia
authors.affiliation: New York Methodist Hospital, Brooklyn, NY.
authors.forename: Pramod
authors.initials: P
authors.lastname: Narula
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care; D057286:Electronic Health Records; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D010372:Pediatrics / Q000193:education*
keywords: I-PASS; educational research; electronic handoff system, intervention; handoff; quality improvement; quality of care; resident education; residents; teaching hospital