Large-Scale Implementation of the I-PASS Handover System at an Academic Medical Centre
BMJ Quality & Safety (03/09/2017) Shahian, David M.; McEachern, Kayla; Rossi, Laura
Healthcare handover quality is a challenging problem associated with preventable errors and adverse outcomes. As part of an effort to examine the issue, Massachusetts General Hospital in Boston completed the first phase of a multifaceted initiative from 2013 to 2016 to implement standardized, structured handovers across all departments, units and direct care providers. A multidisciplinary Handovers Committee selected the I-PASS handover system that involved administrative and clinical leadership support, electronic health record (EHR) templates for I-PASS, concomitant TeamSTEPPS training, unit-level I-PASS champions, and solicitation of caregiver feedback and suggestions. More than 6,000 doctors, nurses and therapists have been trained in the system thus far. According to trended observation scores, there is progressive but non-uniform adoption of I-PASS. The researchers note that comprehensive I-PASS implementation in a large academic medical center calls for significant cultural change. While I-PASS education was straightforward, ensuring consistent and sustained adoption across all services was more demanding, as it required adapting the basic I-PASS structure to local needs and workflows. EHR I-PASS templates helped to improve caregiver acceptance. Initial results are encouraging, and the lessons learned should be helpful to other programs seeking to develop handover initiatives. The second phase of the program highlights uniform and consistent adoption, spread and sustainability.
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