MSSP572: EVALUATING AND IMPLEMENTING A STANDARDIZED HANDOFF FRAMEWORK WITHIN A GENERAL SURGERY RESIDENCY
Katryna K Thomas, MD; Robert C Chick, MD; Olivia Parry, DO; Prashanth Jaisankar, DO; Diane F Hale, MD; Mamie C Stull, MD; Rober W Krell, MD; Brooke Army Medical Center
Objectives: Handoff errors are linked with preventable harms and adverse events. The I-PASS system is a reliable, intuitive, and healthcare specific tool that incorporates all domains of an optimal handoff. In the Military Healthcare System (MHS) specifically, the implementation of a new electronic medical record (EMR) has created an opportunity to utilize a new EMR tool for facilitating handoffs using an I-PASS format. We sought to evaluate whether implementation of an EMR-based handoff tool would improve the quality of handoffs within our Surgery residency.
Methods: This is a quasi-experimental design in which pre- and post-intervention groups were compared on their compliance with I-PASS and perceptions of the handoff system. Participants included PGY-1 surgery residents at our military institution. The intervention consisted of a didactic session about the I-PASS framework and its required elements and mandatory implementation of the new EMR-based handoff tool. Compliance with the I-PASS framework was assessed by observing verbal handoffs and scoring written sign-out tools. Verbal hand-offs for each patient were given one point for each of element within the I-PASS framework that was included in their patient report. Written sign-out tools were collected each night and scored based on their inclusion of all I-PASS elements. An anonymous survey was given to assess residentsâ opinion about the overall quality of handoffs. Handoff and survey scores were compared using nonparametric tests.
Results: During the study period, 23 residents were audited during the handoff process with a total of 205 patients. There was a significant improvement in the scoring of verbal handoff given by each resident after the intervention (3.1 vs. 4.8, p=.022). There were no significant differences in written handoff scores pre- versus post-intervention (5.9 vs. 6.5, p=.45) nor in total time spent giving verbal handoff (9.2 vs. 13.7 minutes, p=.094). Resident familiarity with I-PASS (3.0 vs. 4.4, p=.003) and perceptions of the quality of handoff (2.7 vs 3.6, p=.002) improved pre- versus post-intervention. They found no difference in their ability to answer questions about patient overnight or in the amount of time they spent chart reviewing (71.5 vs 68.3 minutes).
Conclusions: The I-PASS system is an effective tool in decreasing overall handoff errors and preventing potential patient harm. The implementation of a new EMR offers a more effective avenue for creating written sign-out tools, however, further investigation into the barriers to utilization is warranted.