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

Abstract

AbstractBackgroundMiscommunications account for up to 80% of preventable medical errors. Mnemonics structuring these communications, such as I-PASS (Illness severity, Patient summary, Actions list, Situation awareness, Synthesis), have demonstrated a positive impact on the error rates. Currently, physicians our hospital do not follow a particular structure during their hand-offs. We sought to explore the current hand-offs without prior training compared with a gold standard, and with the I-PASS tool in terms of content and sequence.MethodsWe followed a secondary analysis of data collected during a simulation study of a Friday evening hand-off to the night resident. Thirty physicians received a hand-off of 4 patients and were asked to manage two other patients through nursing pages during the start of the night shift, and then generated six sign-outs for a total of 177 sign-outs in this dataset. The gold standard (GS) was defined by a focus group, who reached a consensus on the essential content of each sign-out. The analysis focused on their rate of pertinence and completeness and the exploration of the distribution of the 4 first I-PASS categories and their sequences.ResultsRelevance and completeness rates were 37.2%±0.07 and 51.9%±0.1, respectively, with no significant difference between residents and supervisors, and a positive correlation with total hand-off time (residents: R2=0.62 for relevance and 0.32 for completeness; supervisors: R2 =0,67 and 0.56, respectively). The distribution of I-PAS(S) categories was highly skewed in both GS (I=2%, P=72%, A=17%, S=9%) and participants (I=6%, P=73%, A=14%, S=7%), with significant differences between them for categories A (p=0.046) and I (p≤0.001). The sequences of I-PASS categories followed a general P-A-S-I pattern. The first S category was most frequently absent and only one participant began his hand-off by announcing the severity level of the case as suggested by the I-PASS tool.ConclusionOur results show that a significant number of features handed off were not considered relevant by the GS (pertinence), and that many features considered relevant were not mentioned (completeness), and inversely proportional to the duration of the hand-off. Moreover, current hand-offs differ from the I-PASS tool both in terms of content (frequent absence of categories S and I) and sequence (category I almost never at the beginning). These results highlight clear objectives for future training in medical communications.