title: Real-World Implementation of a Standardized Handover Program (I-PASS) on a Pediatric Clinical Teaching Unit.
abstract: A standardized handover curriculum (I-PASS) has been shown to reduce preventable adverse events in a large multicenter study. We aimed to study the real-world impact of the implementation of this curriculum on handover quality, duration, and identification of unstable patients.
  
  
  
  A prospective intervention study was conducted. We implemented the I-PASS curriculum via faculty education and resident workshops. Resident handover on the clinical teaching unit was videorecorded, and written handover documents were collected for 2 weeks before and after the intervention. We examined the inclusion of key elements on handover documents before and after intervention using logistic regression models accounting for multiple handovers per patient. Duration of handover was compared using a linear regression model adjusting for number of patients. Qualitative content analysis was used to describe observable differences in verbal handover recordings and written critical care consultations.
  
  
  
  A total of 1275 handovers were included, comprising 364 inpatients. There was a significant increase (P < .05) in 7 of 11 key elements and a significant decrease in written physical examination findings after the intervention. No significant change was found in handover duration. Qualitative video analysis revealed observable differences in handover collaboration and organization. After the intervention, patients with critical care needs overnight were correctly identified as requiring close monitoring during handover.
  
  
  
  Handover training resulted in consistent inclusion of key elements and was characterized by collaboration between participants and improved organization without significant increase in handover duration. Appropriate identification and response to clinically deteriorating patients was also found using the I-PASS model.
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Huth
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
authors.forename: Francine
authors.initials: F
authors.lastname: Hart
authors.affiliation: Faculty of Education, University of Ottawa, Ottawa, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Moreau
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Baldwin
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Canada.
authors.forename: Kristy
authors.initials: K
authors.lastname: Parker
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Creery
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Aglipay
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Canada. Electronic address: adoja@cheo.on.ca.
authors.forename: Asif
authors.initials: A
authors.lastname: Doja
mesh_terms: D000046:Academic Medical Centers; D003266:Continuity of Patient Care; D004282:Documentation; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D016015:Logistic Models; D009864:Ontario; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D010372:Pediatrics / Q000193:education*; D011446:Prospective Studies; D012015:Reference Standards; D014741:Video Recording
keywords: handoff; handover; pediatrics; residency education; transitions in care