The I-PASS study, originally published as “Changes in Medical Errors after Implementation of a Handoff Program” for The New England Journal of Medicine in November 2014, helped develop standards that have spread to more than 50 different Children’s and Adult Hospitals. Intermountain was instrumental in developing this protocol.
The Eisenberg Award is presented annually by The Joint Commission and the National Quality Forum. Lead researcher, Raj Srivastava, MD, AVP of research for Intermountain Healthcare and one of six members of the national I-PASS Executive Council, accepting the award April 4, 2017 at the forum’s annual conference in Washington, D.C.
“It’s incredibly humbling to have realized that the work of so many people across the country is being brought to fruition through this award,” says Dr. Srivastava, who also worked with the Primary Children’s research team. “Really, it’s a culmination of so many people in different roles, the front-line caregivers across all these 50 hospitals, all working on this relentless journey toward keeping our patients safer and delivering the highest quality care.”
Scott Stevens, MD, director of the transitional year residency program and vice-chair of the Department of Medicine at Intermountain Medical Center adds: “We’re thrilled by this honor. The Eisenberg Award is probably the nation’s most prestigious national patient safety award, and it’s a great reflection of the commitment and influence of our researchers and our clinical team.”
Primary Children’s Hospital, the Shock-Trauma ICU at Intermountain Medical Center, and the University of Utah’s School of Medicine who collaborated with institutions across the country, were honored for their work to develop, test and implement I-PASS, which is a package of interventions designed to standardize communications during patient handoffs. I-PASS is an acronym for each step of the handoff process:
Illness severity, Patient summary, Action list, Situational awareness and contingency planning, and Synthesis by receiver.
What are the results of I-PASS?
“Standardized handoffs using the I-PASS methodology at Intermountain Medical Center has resulted in improved patient safety without a major effect on efficiency,” says Dr. Stevens. “Since it was first implemented in our Shock-Trauma ICU, it resulted in a 23 percent reduction in medical errors, a 30 percent reduction in preventable adverse events, and a 21 percent reduction in near-misses — while increasing the time per handoff only minimally, from 2.4 minutes to 2.5 minutes.”
The initial project’s results were shared in a multi-center study of pediatric hospitals published in the New England Journal of Medicine in November 2014. They’re important because an estimated 80 percent of the most serious medical errors can be linked to communication failures, particularly during patient handoffs. The study says adverse events affect an estimated 3.7 percent of hospitalized patients — and 14 percent lead to death, yet 69 percent of the events are preventable. More recently, I-PASS has been expanded to include additional hospitals, ICUs as well as hospital wards, and adult as well as pediatric services.
“Our use of I-PASS in the Shock-Trauma ICU at resulted in dramatic improvements in a number of metrics that measure communication quality during handoffs, including the omission of important information, verbally synthesizing the status of each patient, reducing the handoff of inaccurate information, and the overall quality of verbal handoffs,” says Dr. Scott Stevens. “Among its other benefits, fewer patients received unnecessary tests or procedures and there were fewer delays in needed care.”
How I-PASS was developed.
Primary Children’s Hospital and its partner physicians at the University of Utah’s School of Medicine were among the original nine members of the pediatric I-PASS Study Group, which began data gathering in 2011. The I-PASS Study Group now includes more than 150 individuals in more than 50 children’s and adult hospitals nationwide. In 2015, the I-PASS handoff tool was implemented in the Shock-Trauma ICU at Intermountain Medical Center.
I-PASS is being expanded to include family-centered rounding.
Primary Children’s and the University of Utah’s School of Medicine are among seven pediatric sites nationwide participating in a study using the I-PASS model in family-centered rounding. “The I-PASS model is way of looking at healthcare and its delivery, and finding innate ways to integrate interventions within the system to improve patient safety,” says Brian Good, MD, of the University of Utah’s School of Medicine and a hospitalist at Primary Children’s. “In family-centered rounding, it starts a discussion about what’s most important in the care of each patient,” he said. “In the end, patients are better off for that.”
Family-centered rounding is a practice in which doctors’ daily patient rounds are done in the presence of patients and their families. This enables open discussion of a child’s diagnosis, treatment, and care plan, and allows families and nurses to ask questions and provide input as part of that process.
Patient perspective: Better communication means better care.
“I-PASS has shined a light on parts of the care process where there were common gaps, and ways we could better address those obstacles,” says Eileen Christensen, the parent of a former Primary Children’s patient, who serves on local and national I-PASS committees to provide feedback and engage caregivers in simulated family rounding experiences. “I appreciate so much the involvement I’ve had and being able to have a voice and have it met receptively,” she says. “You get a sense that Primary Children’s wants to make improvements, and that they care.”
Data collection on family-centered rounding is complete and analysis is underway, says Irene Kocolas, MD, of the University of Utah’s School of Medicine and Primary Children’s Hospital. She says preliminary results are promising, and will be presented in the annual Pediatric Academic Societies Meeting May 6-9 in San Francisco.
“We’re honored to be part of this group and very privileged to have the highest administrative support for these studies,” Dr. Kocolas says. “We have a passion for what we do. The need for better communication has been expressed by our families and our nurses enough to say we can do a better job. We’ve taken that enthusiasm and had a chance to move that forward, and seeing the results so far has been very humbling.”
The next step for I-PASS at Intermountain Medical Center is to implement its communication methodology between hospital and office physicians at the time of patient discharge. Intermountain Medical Center has joined the I-PASS collaboration in a grant application to implement this new phase of I-PASS.