Resident Experiences With Implementation of the I-PASS Handoff Bundle

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Abstract

Background

The I-PASS Handoff Study found that introduction of a handoff bundle (handoff and teamwork training for residents, a mnemonic, a handoff tool, a faculty development program, and a sustainability campaign) at 9 pediatrics residency programs was associated with improved communication and patient safety.

Objective

This parallel qualitative study aimed to understand resident experiences with I-PASS and to inform future implementation and sustainability strategies.

Methods

Resident experiences with I-PASS were explored in focus groups (N = 50 residents) at 8 hospitals throughout 2012–2013. A content analysis of transcripts was conducted following the principles of grounded theory.

Results

Residents generally accepted I-PASS as an ideal format for handoffs, and valued learning a structured approach. Across all sites, residents reported full adherence to I-PASS when observed, but selective adherence in usual practice. Residents adhered more closely when patients were complex, teams were unfamiliar, and during evening handoff. Residents reported using elements of the I-PASS mnemonic variably, with Illness Severity and Action Items most consistently used, but Synthesis by Receiver least used, except when observed. Most residents were receptive to the electronic handoff tool, but perceptions about usability varied across sites. Experiences with observation and feedback were mixed. Concern about efficiency commonly influenced attitudes about I-PASS.

Conclusions

Residents generally supported I-PASS implementation, but adherence was influenced by patient type, context, and individual and team factors. Our findings could inform future implementation, particularly around the areas of resident engagement in change, sensitivity to resident level, perceived efficiency, and faculty observation.

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Author and article information

Journal

Journal ID (nlm-ta): J Grad Med Educ

Journal ID (iso-abbrev): J Grad Med Educ

Journal ID (publisher-id): jgme

Title: Journal of Graduate Medical Education

Publisher: The Accreditation Council for Graduate Medical Education

ISSN (Print): 1949-8349

ISSN (Electronic): 1949-8357

Publication date (Print): June 2017

Volume: 9

Issue: 3

Pages: 313-320

Author notes

Maitreya Coffey, MD, is Associate Professor of Paediatrics and Medical Safety Officer, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada, and Associate Clinical Director, Children's Hospitals Solutions for Patient Safety; Kelly Thomson, PhD, is Assistant Professor, School of Administrative Studies, York University, Toronto, Ontario, Canada; Shelly-Anne Li, MSc, is PhD Research Trainee, The Hospital for Sick Children; Zia Bismilla, MD, MEd, is Assistant Professor of Paediatrics, The Hospital for Sick Children and University of Toronto; Amy J. Starmer, MD, MPH, is Assistant Professor of Pediatrics, Department of Medicine, Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School; Jennifer K. O'Toole, MD, MEd, is Associate Professor of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Rebecca L. Blankenburg, MD, MPH, is Associate Professor of Pediatrics, Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital Stanford and Stanford School of Medicine; Glenn Rosenbluth, MD, is Associate Professor of Pediatrics, Benioff Children's Hospital, University of California, San Francisco; F. Sessions Cole, MD, is Professor of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine; Clifton E. Yu, MD, is Professor of Pediatrics, Walter Reed National Military Medical Center; Jennifer H. Hepps, MD, is Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences; Theodore C. Sectish, MD, is Professor, Department of Medicine, Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School; Nancy D. Spector, MD, is Professor of Pediatrics, Section of General Pediatrics, St. Christopher's Hospital for Children; Rajendu Srivastava, MD, MPH, is Professor of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, and Institute for Health Care Delivery Research, Intermountain Healthcare; April D. Allen, PhD, MPA, is Visiting Scholar, Heller School for Social Policy and Management, Brandeis University; Sanjay Mahant, MD, MSc, is Associate Professor of Paediatrics, The Hospital for Sick Children and Institute for Health Policy, Management, and Evaluation, University of Toronto; and Christopher P. Landrigan, MD, MPH, is Associate Professor of Pediatrics and Medicine, Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, and Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, both at Harvard Medical School.

Funding: This study was fully funded by the Physician Services Incorporated Foundation, Toronto, Ontario, Canada, and the US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

Conflict of interest: The authors declare they have no competing interests.

Editor's Note: The online version of this article contains the I-PASS Qualitative Study Resident Focus Group Guide .

Corresponding author: Maitreya Coffey, MD, University of Toronto, Centre for Quality Improvement and Patient Safety, 525 University Avenue, Toronto, ON M5G 1X8 Canada, 416.813.7654, trey.coffey@ 123456sickkids.ca

Article

Accession ID: PMC5476380 Pmcid ID: PMC5476380 Pmc-uid ID: 5476380 Serial Item and Contribution ID: jgme-09-03-32 Publisher ID: Customer: JGME-D-16-00616

DOI: 10.4300/JGME-D-16-00616.1

PMC ID: 5476380

PubMed ID: 28638509

SO-VID: bfca8d0e-b6f4-48fe-972a-bdbb6d045411

History

Date received : 30 September 2016

Date revision received : 17 January 2017

Date revision received : 31 January 2017

Date accepted : 7 February 2017

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