Enhancing Implementation of the I-PASS Handoff Tool Using a Provider Handoff Task Force at a Comprehensive Cancer Center

Abstract

Communication failures are among the most common causes of harmful medical errors. At our Comprehensive Cancer Care Center patient handoffs varied among services. We describe the implementation and results of an organization wide project to improve handoffs and implement an evidence-based handoff tool across all inpatient services. We created a task force composed of members from 22 hospital services—advanced practice providers (APPs), trainees, some faculty members, electronic health record (EHR) staff, education and training specialists, and nocturnal providers. Over two years, the task force expanded to include consulting services and Anesthesiology. Factors contributing to ineffective handoffs were identified and organized into categories. The EHR I-PASS tool was used to standardize handoff documentation. Training was provided to staff on its use, and compliance was monitored using a customized dashboard. I-PASS champions in each service were responsible for the rollout of I-PASS in their respective services. The data were reported quarterly to our Quality Assessment and Performance Improvement (QAPI) governing committee. Provider handoff perception was assessed through the biennial institution wide safety culture survey. All fellows, residents, APPs, and physician assistants were trained in the use of I-PASS, either online or in person. Adherence to the I-PASS written tool improved from 41.6% in 2019 to 70.5% in 2022 (p < 0.05), with improvements seen in most services. The frequency of updating I-PASS elements and the action list in the handoff tool also increased over time. The handoff favorability score on the safety culture survey improved from 38% in 2018 to 59% in 2022. The implementation approach developed by the Provider Handoff Task Force led to increased use of the I-PASS EHR tool and improved safety culture survey handoff favorability. Communication failures are among the most common causes of medical errors that harm patients. According to The Joint Commission,1 67% of communication errors are related to handoffs (the communication of key information at the time of transition of patient care responsibility from one provider to another, such as at change of shift or location in the hospital). Based on a 2018 human factors analysis of safety events at our institution, communication/coordination was the greatest concern among all domains, and handoffs were one of the root causes of miscommunication safety events.

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