title: Large-scale implementation of the I-PASS handover system at an academic medical centre.
abstract: BACKGROUND
  Healthcare has become increasingly complex and care delivery models have changed dramatically (eg, team-based care, duty-hour restrictions). However, approaches to critical communications among providers have not evolved to meet these new challenges. Evidence from safety culture surveys, academic studies and malpractice claims suggests that healthcare handover quality is problematic, leading to preventable errors and adverse outcomes. To address this concern, from 2013 to 2016 Massachusetts General Hospital completed phase I of a multifaceted programme to implement standardised, structured handovers across all departments, units and direct care providers.
  
  
  METHODS
  A multidisciplinary Handovers Committee selected the I-PASS handover system. Phase I implementation focused on large-scale training and shift-to-shift handovers. Important features included administrative and clinical leadership support; EHR templates for I-PASS; hospital handover policy revision; varied educational modalities, venues and durations; concomitant TeamSTEPPS training; unit-level I-PASS champions; handover observations; and solicitation of caregiver feedback and suggestions.
  
  
  RESULTS
  More than 6000 doctors, nurses and therapists have been trained. Trended observation scores demonstrate progressive but non-uniform adoption of I-PASS, with significant improvements in the correct sequencing and percentage of I-PASS elements included in handovers. Adoption of Synthesis (readback) has been challenging, with lower scores.
  
  
  CONCLUSIONS
  Comprehensive I-PASS implementation in a large academic medical centre necessitated major cultural change. I-PASS education is straightforward, whereas assuring consistent and sustained adoption across all services is more challenging, requiring adaptation of the basic I-PASS structure to local needs and workflows. EHR I-PASS templates facilitated caregiver acceptance. Initial phase I results are encouraging and the lessons learned should be helpful to other programmes planning handover initiatives. Phase II is ongoing, focusing on more uniform and consistent adoption, spread and sustainability.
authors.affiliation: Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA.
authors.forename: Kayla
authors.initials: K
authors.lastname: McEachern
authors.affiliation: Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Norman Knight Center for Clinical and Professional Development, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Roger Gino
authors.initials: RG
authors.lastname: Chisari
authors.affiliation: Center for Quality and Safety and Department of Medicine, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA.|Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mort
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D057188:Workflow
keywords: Communication; Hand-off; Human factors; Patient safety; Transitions in care