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Hospital Medical Errors Reduced 30% With Improved Patient Handoffs

Authors aim to improve provider-to-provider communication

Improvements in verbal and written communication between health care providers during patient handoffs can reduce injuries due to medical errors by 30%, according to a multicenter study led by researchers at Boston Children’s Hospital.

Reported November 6 in the New England Journal of Medicine, the study results show that I-PASS — a new system of bundled communication and training tools for handoff of patient care between providers — can increase patient safety without significantly burdening existing clinical workflows.

Medical errors in hospitals, such as diagnostic delays, preventable surgical complications, and medication overdoses, are a leading cause of death and injury in the U.S. An estimated 80% of the most serious medical errors can be linked to communication between clinicians, particularly during patient handoffs. For example, a handoff-related medical error could occur if information about a critical diagnostic test is not communicated correctly between providers at shift change; the result could be a potentially harmful delay in patient care.

“Miscommunications and handoff errors are two of the most significant causes of medical errors in hospitals in the U.S.,” said senior author Christopher Landrigan, MD, MPH, of Boston Children’s Division of General Pediatrics. “This is the first multicenter handoff improvement program that has been found to reduce injuries due to medical errors.”

A multicenter team led by Landrigan designed I-PASS with the goal of improving patient safety and reducing or eliminating the most common source of medical errors through improved provider-to-provider communication. I-PASS consists of:

  • Standardized communication and handoff training
  • A verbal handoff process organized around the verbal mnemonic “I-PASS” (Illness severity; Patient summary; Action list; Situational awareness and contingency planning; and Synthesis by receiver)
  • Computerized handoff tools to share patient information between providers using an I-PASS structure
  • Engagement of supervising attending physicians to observe and oversee handoff communications
  • A campaign promoting the adoption of I-PASS as part of institutional process and culture

In the NEJM paper, patient handoffs by residents were monitored and assessed for a 6-month pre-intervention period at nine U.S. hospitals. During this intervention phase, residents were trained on I-PASS handoff processes and were required to use the system going forward. An additional 6 months of monitoring and assessment followed the intervention.

Across the participating centers, the overall rate of medical errors decreased by 23% — from 24.5 to 18.8 errors per 100 admissions — after the introduction of I-PASS. Preventable adverse events (i.e., injuries due to medical errors) decreased by 30% — from 4.7 to 3.3 errors per 100 admissions. The research team’s data covered a total of 10,740 patient admissions.

Time-motion analyses of providers’ activities showed that implementing I-PASS did not add time to patient handoffs or decrease time spent at patient bedsides or on other tasks. The researchers noted significant improvements in residents’ verbal and written communications at every center and a significant increase in residents’ satisfaction with the quality of their patient handoffs after I-PASS implementation, according to a post-study survey.

Landrigan and his colleagues note that while the I-PASS bundle has been focused on inpatient pediatric care, the principles are applicable to care in any hospital inpatient setting. And while not documented in the study, they believe that the safety improvements supported by the adoption of I-PASS could lead to substantial reductions in medical error-related health care costs.

Sources: NEJM; November 6, 2014; and MedicalXpress; November 5, 2014.

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