I-PASS Handoff Curriculum: Medical Student Workshop

Publication ID Published Volume
9854 August 5, 2014 10

Abstract

Following the implementation of the immensely popular I-PASS handoff program at 9 residency programs across North America, I-PASS study investigators began receiving requests to adapt the curricular materials to meet the needs of medical students. Medical students assume patient care responsibilities, including participating in patient handoffs, and function as members of inter-professional teams as soon as they begin their clinical rotations in medical school. They often assume these roles with little supervision and oversight. In addition, at many medical schools handoff training is not a standard component of the curriculum. In response to these requests, I-PASS study investigators developed a specialized I-PASS handoff training curriculum for medical students as the seventh component to the I-PASS suite of materials.

Similar in content to the I-PASS Handoff Core Resident Workshop, this workshop has been tailored to fit the needs of medical students as novice clinicians with limited clinical experience and emerging medical knowledge. This curriculum was implemented for 3rd and 4th year medical students during their inpatient pediatric rotations from June – December 2013 at six medical schools and pediatric hospitals across North America including: (1) University of Cincinnati College of Medicine/Cincinnati Children’s Hospital Medical Center; (2) UCSF School of Medicine/Benioff Children’s Hospital; (3) University of Utah School of Medicine/Primary Children’s Medical Center; (4) Drexel University College of Medicine/St. Christopher’s Hospital for Children; (5) University of Toronto Faculty of Medicine/Hospital for Sick Children; and (6) Stanford University School of Medicine/Lucile Packard Children’s Hospital.

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

Regulatory agencies estimate that roughly 2/3rds of sentinel events in hospitals involve miscommunication between caregivers when patients are transferred or handed off from one care provider to another. Due to recent changes in both clinical and educational requirements, handoffs have increased in frequency in academic health centers. Despite the increase in the numbers of handoffs, few standardized, rigorously studied handoff training programs exist in residency programs and medical schools.

The I-PASS Handoff Curriculum Collection was 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 six major complimentary components:

  1. I-PASS Handoff Curriculum: Core Resident Workshop
  2. I-PASS Handoff Curriculum: Handoff Simulation Exercises
  3. I-PASS Handoff Curriculum: Computer Module
  4. I-PASS Handoff Curriculum: Campaign Toolkit
  5. I-PASS Handoff Curriculum: Faculty Development Resources
  6. I-PASS Handoff Curriculum: Faculty Observation Tools

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

O'Toole J, Calaman S, Everhart J, et al. I-PASS handoff curriculum: medical student workshop. MedEdPORTAL Publications. 2014;10:9854. http://doi.org/10.15766/mep_2374-8265.9854

Educational Objectives

  1. Describe the importance of effective communication in reducing medical errors.
  2. Detail the essential content and sequence of effective handoffs.
  3. Apply effective team training strategies to improve handoffs.
  4. Practice handoff skills.

Keywords

  • Handoffs, Clinical Handoffs, Medical Students, Handoff Simulations, IPASS

References

  1. "Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Tools and Materials." http://www.ahrq.gov/. N.p., n.d. Web. 6 Feb 2012. http://teamstepps.ahrq.gov/abouttoolsmaterials.htm.
  2. Bordage, G. "Prototypes and Semantic Qualifiers: From Past to Present." Medical Education. 41.12 (2007): 1117-21. http://dx.doi.org/10.1111/j.1365-2923.2007.02919.x
  3. Cohen, M.D., and Hilligoss, P.B. "The Published Literature on Handoffs in Hospitals: Deficiencies Identified in an Extensive Review. " Quality and Safety in Health Care. 19.6 (2010): 493-497. http://dx.doi.org/10.1136/qshc.2009.033480
  4. Kaplan, D.M. "Perspective: Whither the Problem List Organ-Based Documentation and Deficient Synthesis by Medical Trainees." Academic Medicine. 85.10 (2010): 1578-1582. http://dx.doi.org/10.1097/ACM.0b013e3181f06c67
  5. Starmer, A.J., Spector, N.D., Srivastava, R., Allen, A.D., Landrigan, C.P., Sectish, T.C. et al. "I-PASS, a Mnemonic to Standardize Verbal Handoffs." Pediatrics. 129.2 (2012): 201-204. http://dx.doi.org/10.1542/peds.2011-2966
  6. Starmer AJ, Sectish TC, Simon DW, Keohane C, McSweeney ME, Chung EY, Yoon CS, Lipsitz SR, Wassner AJ, Harper MB, Landrigan CP. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. 2013 Dec 4;310(21):2262-70. http://dx.doi.org/10.1001/jama.2013.281961
  7. O’Toole JK, Stevenson AT, Good BP, Guiot AB, Solan LG, Tse LL, Landrigan CP, Sectish TC, Srivastava R, Starmer AJ, Spector ND. Closing the Gap: Medical Students and Handoff Training. Journal of Pediatrics. 2013 May ; 162(5) : 887-888. http://dx.doi.org/10.1016/j.jpeds.2013.01.045

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ISSN 2374-8265