I-PASS Handoff Curriculum: Handoff Simulation Exercises

Publication ID Published Volume
9402 April 26, 2013 9

Abstract

I-PASS role-plays are simulation exercises that serve to bring all the I-PASS curricular elements together. The role-plays allow practice with the techniques and include resident and faculty feedback to help learners refine the skills learned and place them in context. Three role-plays involve performing an I-PASS handoff with a giver, receiver, and observer. Communication challenges, such as interruptions, are introduced in later role-plays to increase complexity as learners go through the exercises. The observer uses the faculty observation tools that faculty will subsequently use to evaluate live handoffs. The final role-play focuses on developing a shared mental model. In this exercise, each group of three is divided into a giver and two receivers who develop the action items and situation awareness and contingency planning portions of the written handoff based on the information from the giver. Neighboring groups perform the same exercise with slightly different information and then compare their success in developing a shared mental model.

A detailed article describing the development, implementation, and dissemination of the I-PASS Handoff Curriculum can be found at Academic Medicine 2014; 89(6): 876-884. PMID: 24871238.

Goals of the I-PASS Handoff Curriculum for Residents:

  • Understand the context of medical errors associated with communication failures
  • Introduce the TeamSTEPPS(TM) model of team training with an emphasis on leadership skills, training strategies, and communication skills in order to optimize team function
  • Learn the global elements of effective verbal and printed handoffs
  • Know the elements of an effective verbal handoff
  • Know the elements of an effective printed handoff document
  • Adopt the I-PASS mnemonic
  • Use high quality patient summaries to convey clinical information concisely and effectively in a handoff
  • Incorporate contingency planning in clinical care, especially in handoffs

Goals of the I-PASS Handoff Curriculum for Faculty:

  • Understand the role of a faculty champion in the I-PASS handoff program
  • Learn and be able to use the I-PASS handoff technique
  • Understand the elements and organization of the Core Resident Workshop and Handoff Simulation Exercises
  • Introduce the faculty observation process for the I-PASS handoff program

The I-PASS Handoff Curriculum: Handoff Simulation Exercise is one of seven submissions which are part of the I-PASS Handoff Curriculum Collection, created by a group of pediatric educators, health services researchers, and hospitalists to teach a standardized approach to handoffs in inpatient settings. This collection is a comprehensive, evidence-based, and consensus-driven suite of educational materials created for a multi-site study that consists of seven major complementary components:

  1. I-PASS Handoff Curriculum: Core Resident Workshop, a 2-hour didactic and interactive session that teaches I-PASS techniques and concept

  2. I-PASS Handoff Curriculum: Handoff Simulation Exercises, a 1-hour interactive role-play session to allow for practicing of techniques learned in the resident workshop or computer module

  3. I-PASS Handoff Curriculum: Computer Module, an electronic tool that allows for independent learning and review of I-PASS concepts and techniques

  4. I-PASS Handoff Curriculum: Campaign Toolkit, a collection of materials to ensure adoption and implementation of the I-PASS handoff process and change institutional culture

  5. I-PASS Handoff Curriculum: Faculty Development Resources, a set of resources to educate and train faculty or handoff champions for the implementation of the I-PASS handoff program

  6. I-PASS Handoff Curriculum: Faculty Observation Tools, a series of assessment tools designed to be used by institutions implementing the I-PASS handoff process

  7. I-PASS Handoff Curriculum: Medical Student Workshop

The results of the multisite I-PASS Handoff Study are published and available at the New England Journal of Medicine 2014; 371: 1803-1812. PMID: 25372088.

In brief, we found in a detailed review of 10,740 patient admissions that a 23% reduction in medical errors and a 30% reduction in injuries due to medical errors (preventable adverse events) occurred following implementation of the I-PASS Handoff Bundle in 9 academic medical centers.  In direct observation of thousands of hours of resident workflow (time motion analysis) before and after implementation of the program, conducting handoffs using the I-PASS method was found to require no more time per handoff, and resident workflow throughout the shift was likewise unchanged, including no change in the amount of time spent at the computer or in direct patient care.

Citation

Calaman S, Hepps J, Spector N, et al. I-PASS handoff curriculum: handoff simulation exercises. MedEdPORTAL Publications. 2013;9:9402. http://doi.org/10.15766/mep_2374-8265.9402

Educational Objectives

  1. To practice handoff skills.
  2. To demonstrate the importance of creating a shared mental model.

Keywords

  • Handoff, Role Playing, Handovers, Signout, Transfer, Inpatient Setting, IPASS

References

  1. Tierney T and Nestel D. Role-play for medical students learning about communication: Guidelines for maximising benefits. BMC Medical Education 2007; 7: 3. http://doi.org/10.1186/1472-6920-7-3
  2. Joyner B and Young L. Teaching students using role play: Twelve tips for successful role plays. Medical Teacher 2006; 28(3): 225-9. http://doi.org/10.1080/01421590600711252
  3. Steinhert Y. Twelve tips for using role plays in clinical teaching. Medical Teacher 1993; 15(4): 283-291. http://doi.org/10.3109/01421599309006651

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ISSN 2374-8265