Residents and faculty alike are far more empowered to ask for clarification, and residents have dramatically improved their ability to perform the skill of contingency planning. On the whole, it is very clear that there is more collective attention to handoff quality. Pilot data indicates that this intervention decreases medical errors and improves handoff quality without compromising efficiency. In order to provide role modeling and re-enforcement of skills, we have utilized I-PASS faculty development tools and handoff observation and feedback tools. The third component of the bundle, the electronic handoff tool, is created using existing clinical information systems in a format that follows the I-PASS format and auto-imports information such as allergies and medications. Phase 1 comprised preintervention handoffs before I-PASS phase 2, initiating I-PASS mnemonic and educational session and phase 3, implementing a handoff. This is followed by a small group simulated handoff experience. The teamwork training consists of a one-hour session using slides and videos, followed by a one-hour introduction to structured verbal communication using a mnemonic, “I-PASS,” created through resident input and a series of expert panels. The resulting intervention consists of a ‘bundle’ of 3 elements: teamwork training, structured verbal handoff communication, and an electronic handoff tool. The mnemonic stands for Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by the receiver. As the sole Canadian site participating in this ten-site collaborative, we have created and implemented an innovative handoff intervention based on an established framework for optimal communication and team functioning (TeamSTEPPS) and developed through a collaboration of educators, practitioners, patient safety researchers, and QI experts. Recognizing a lack of training and paucity of tools to support quality handoffs, SickKids joined a collaborative project known as I-PASS, IIPE-PRIS Accelerating Safe Signouts project. Simultaneously, the harmful effects of provider fatigue have prompted duty hour restrictions which create more handoffs of care. Communication breakdown is a common root cause of serious medical errors.
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