As someone who works with residents, I’ve learned to judge reasonably well when my residents have mastered a skill or have acquired good judgment in particular situations. Despite this, I live by the mantra “trust but verify”. The challenge comes when I am not around and the residents are indirectly supervised. One of the times when there is a real potential for patient harm is during the handoff when one on-call resident is passing their patient to another resident.

As it turns out, this isn’t just a dangerous situation for podiatric residents and their patients. In fact, all patients run the risk of experiencing complications or adverse events as a result of failed handoffs, which boil down to failures in communication. It stands to reason, then, that improved communication during the handoff is one major opportunity for us to advance patient safety.

Consider Adopting the I-PASS Method for Patient Handoffs

One method that has been advocated is the I-PASS handoff mnemonic. I-PASS is a standardized method for two medical professionals to communicate during this time to cover the most pertinent aspects of a patient’s care. I-PASS was created as a modification of the “I PASS THE BATON” mnemonic from the TeamSTEPPS teamwork system (an excellent system itself for anyone interested). During the creation of the I-PASS system, residents were surveyed, and it was determined that a shorter system that was easier to recall would be more successful¹.

Here’s the I-PASS mnemonic¹:

This is a nicely designed system that is relatively simple to remember and use while covering the most important issues. Of course, the big question for any of these systems is, are they effective in reducing miscommunications and errors leading to adverse events for our patients?

It’s Simple to Use and It Works

Starmer and colleagues, of the I-PASS Study Group, performed a prospective intervention study using the I-PASS system in nine pediatric residency programs². They educated the 912 participating residents with several hours of workshops and practice sessions and then made the I-PASS method (in both written and verbal formats) mandatory for handoffs. The researchers then began the study itself, with a pre-intervention phase of six months (5516 admissions), an intervention phase (5516 admissions), and an intervention phase (5224 admissions). They analyzed the following outcomes between the pre- and post-intervention phases: medical errors, adverse events, resident workflow patterns and satisfaction.

The results between the pre- and post-intervention periods were as follows²:

The outcomes of this study are promising and provide us with reasonably solid evidence that the I-PASS handoff method is effective in making medicine safer for our patients. Communication is fraught with problems, and coupled with the complexity of medicine, is a major cause of errors and complications. Providing a systematic handoff eliminates much of the potential for error. Consider using I-PASS for your handoffs.