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Link to original content: http://pubmed.ncbi.nlm.nih.gov/39334190/
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. 2024 Sep 27;24(1):1046.
doi: 10.1186/s12909-024-05880-7.

Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic

Aurélie Huber  1 , Belinda Moyano  2 , Katherine Blondon  2   3
Affiliations

Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic

Aurélie Huber et al. BMC Med Educ. .

Abstract

Background: Miscommunications account for up to 80% of preventable medical errors. Mnemonics like I-PASS (Illness severity, Patient summary, Actions list, Situation awareness, Synthesis) have demonstrated a positive impact on reducing error rates. Currently, physicians at our hospital do not follow a specific structure during hand-offs. We aimed to compare current hand-offs without prior training to a gold standard and the I-PASS tool in terms of content and sequence.

Methods: This study is a secondary analysis of data collected during a simulation study of a Friday evening hand-off to the night resident at University Hospitals of Geneva. Thirty physicians received a hand-off of four patients and managed two other patients through nursing pages at the start of the night shift, generating six sign-outs each, totaling 177 sign-outs. A focus group of three senior doctors defined the gold standard (GS) by consensus on the essential content of each sign-out. The analysis focused on the rates of relevance (ratio of information considered relevant by the GS) and completeness (proportion of transmitted elements out of all expected elements of the GS), and the distribution and sequence of the first four I-PASS categories.

Results: Relevance and completeness rates were 37.2% ± 0.07 and 51.9% ± 0.1, respectively, with no significant difference between residents and supervisors. There was a positive correlation between total hand-off time and relevance (residents: R2 = 0.62; supervisors: R2 = 0.67) and completeness (residents: R2 = 0.32; supervisors: R2 = 0.56). The distribution of I-PASS categories was highly skewed in both the GS (I = 2%, P = 72%, A = 17%, S = 9%) and participants (I = 6%, P = 73%, A = 14%, S = 7%), with significant differences in categories A (p = 0.046) and I (p ≤ 0.001). Sequences of I-PASS categories generally followed a P-A-S-I pattern. The first S category was frequently absent, and only one participant began by announcing the case severity as suggested by I-PASS.

Conclusion: We identified gaps between current medical sign-outs in our institution's general internal medicine division and the I-PASS structure. We recommend implementing the I-PASS mnemonic, emphasizing the "I" category at the start and the "S" category to anticipate and prevent complications. Future studies should assess the impact of this recommendation, adapt the mnemonic elements to the context, and introduce specific hand-off training for senior medical students.

Keywords: Completeness; Hand-off; I-PASS; Relevance; Sign-out.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
a and b Relevance rate by the residents and the supervisors. Relevance rates (ordinate, %) by participant (abscissa, one column per participant) in the residents’ group (Fig. 1a, solid fill) and the supervisor group (Fig. 1b, dashed fill), ordered by increasing scores
Fig. 2
Fig. 2
Effects of the hand-off’s duration on its relevance, by level of expertise. Relevance rate (ordinate, %) by the duration of the hand-off (abscissa, minutes) in the residents’ group (red triangles) and the supervisors’ group (black circles)
Fig. 3
Fig. 3
a et b): Completeness rate by the residents and the supervisors. Completeness rates (ordinate, %) by participant (abscissa, one column per participant) in the residents’ group (Fig. 3a, solid fill) and the supervisor group (Fig. 3b, dashed fill), ordered by increasing scores
Fig. 4
Fig. 4
Effects of the hand-off’s duration on its completeness, by level of expertise. Completeness rate (ordinate, %) by the duration of the hand-off (abscissa, minutes) in the residents’ group (red triangles) and the supervisors’ group (black circles)
Fig. 5
Fig. 5
a and b Correlation between relevance and completeness of hand-offs, by level of expertise. Relevance (orange, ordinate, %) and completeness (blue, ordinate, %) rates in the residents’ group (Fig. 5a, circles) and the supervisor group (Fig. 5b, triangles) in ascending order of scores
Fig. 6
Fig. 6
a and b: I-PAS(S) categories’ distribution in sign-outs, by the gold standard and by the participants. Distribution of information transmitted according to I-PAS(S) categories (Illness severity, Patient summary, Actions list, Situation awareness). The graph on the left (Fig. 6a) represents the average of the 30 participants and the graph on the right (Fig. 6b) illustrates the distribution within the gold standard sign-out
Fig. 7
Fig. 7
I-PAS(S) categories’ repartition for the eight clinical cases, by the gold standard and by the participants. Distribution of reported information according to I-PAS(S) categories based on the 8 clinical cases for the average of the 30 participants (left column) and for the gold standard (right column)
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References

    1. Handoffs and Signouts. PSNet [internet]. Rockville: Agency for Healthcare Research and Quality, US Department of Health and Human Services; 2019.
    1. Starmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, et al. Changes in Medical Errors after Implementation of a Handoff Program. N Engl J Med. 2014;371(19):1803–12. - PubMed
    1. Starmer AJ, Sectish TC, Simon DW, Keohane C, McSweeney ME, Chung EY, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. 2013;310(21):2262–70. - PubMed
    1. Till A, Sall H, Wilkinson J. Safe Handover : Safe Patients - The Electronic Handover System. BMJ Qual Improv Rep. 2014;2(2):u202926.w1359. - PMC - PubMed
    1. Cohen HG. Medication errors–a system problem. Todays Surg Nurse déc. 1998;20(6):24–8. - PubMed

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