344 - IPASS Handoff Note in the Pediatric Emergency Department

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 344
Publication Number: 344.209

Deborah Hammett, Nemours Children's Hospital, West Chester, PA, United States; Rebecca Matta, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Jody C. Kieffer, Nemours Children's Hospital, Delaware, Wilmington, DE, United States; Jillian Savage, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Nadine Smith, Nemours Children's Hospital, Mount Laurel, NJ, United States; Courtney Nelson, NemoursAlfred I. duPont Hospital for Children, Berwyn, PA, United States

Presenting Author(s)

Deborah Hammett, D.O. (she/her/hers)

Pediatric Emergency Medicine Fellow
Nemours Children's Hospital
West Chester, Pennsylvania, United States

Background: The I-PASS (illness severity, patient summary, action list, situation awareness/contingency planning, and synthesis by receiver) handoff tool is often used as a reliable method to guide provider handoff and reduce adverse events in the inpatient setting. Transitions in care occur frequently in the Emergency Department (ED) and the unpredictable environment can lead to less structured provider handoffs.

Objective:

Our aim was to increase the number of handoff notes containing 4 key I-PASS components by 20% over 6 months.

Design/Methods: We developed a handoff note template for the pediatric ED which included 4 key I-PASS elements: illness severity, patient care summary, action list, and situational awareness/contingency planning. We conducted provider education in March 2022. From May-July 2022, a working group of 5 ED physicians used the template and completed rapid plan-do-study-act (PDSA) cycles to optimize the note framework prior to going live in August 2022. Our primary outcome measure was the percentage of handoff notes containing 4 I-PASS elements. Our process measure was the percent of handoff notes utilizing the template. Our balancing measure was the percentage of handoffs with no note. We included all encounters where a transition in care occurred as documented by the first attending of record. We excluded all patients with behavioral health complaints, as they have a separate sign out process. We analyzed a random sample of 20 charts per month in our pre-implementation phase (August- July 2022) and post implementation phase (August 2022-December 2022). We completed monthly PDSA cycles to review note usage and identify obstacles to successful note utilization. Process improvements included minor note template changes, improving note accessibility within the electronic medical record, and designating computer workstations for timely handoff note completion.

Results:

We assessed 240 handoff notes to determine the pre-implementation baseline and evaluated 100 handoff notes post-implementation. Post-implementation, 59.0% of handoff notes contained 4 IPASS elements compared to 0% prior to our intervention (Figure 1). Similarly, handoff template utilization increased to 81.0% from 0% (Figure 2). There was no change in handoffs without documentation.

Conclusion(s):

Utilizing a standardized note template for provider handoff documentation improved adherence with the I-PASS handoff tool in the pediatric ED.