Adapting the I-PASS Handoff Program for Emergency Department Inter-Shift Handoffs.
BACKGROUND
Academic emergency department (ED) handoffs are high-risk transfer of care events. Emergency medicine residents are inadequately trained to handle these vital transitions. We aimed to explore what modifications the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) handoff system requires to be effectively modified for use in ED inter-shift handoffs.


METHODS
This mixed-method needs assessment conducted at an academic ED explored the suitability of the I-PASS system for ED handoffs. We conducted a literature review, focus groups, and then a survey. We sought to identify the distinctive elements of ED handoffs and discern how these could be incorporated into the I-PASS system.


RESULTS
Focus group participants agreed the patient summary should be adapted to include anticipated disposition of patient. Participants generally endorsed the order and content of the other elements of the I-PASS tool. The survey yielded several wording changes to reflect contextual differences. Themes from all qualitative sources converged to suggest changes for brevity and clarity. Most participants agreed that the I-PASS tool would be well suited to the ED setting.


CONCLUSIONS
With modifications for context, brevity, and clarity, the I-PASS system may be well suited for application to the ED setting. This study provides qualitative data in support of using the I-PASS tool and concrete suggestions for how to modify the I-PASS tool for the ED. Implementation and outcome research is needed to investigate if the I-PASS tool is feasible and improves patient outcomes in the ED environment.
Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon.
James A
JA
Heilman
Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon.
Moira
M
Flanigan
Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon.
Anna
A
Nelson
Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon.
Tom
T
Johnson
Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon.
Lalena M
LM
Yarris
D004636:Emergency Service, Hospital / Q000592:standards*; D017144:Focus Groups; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000592:standards*; D020380:Needs Assessment / Q000458:organization & administration; D062209:Patient Handoff / Q000592:standards*; D010820:Physicians; D016730:Program Development; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires