Share this article on:

Development, Implementation, and Dissemination of the I-PASS Handoff Curriculum: A Multisite Educational Intervention to Improve Patient Handoffs

Starmer, Amy J. MD, MPH; O’Toole, Jennifer K. MD, MEd; Rosenbluth, Glenn MD; Calaman, Sharon MD; Balmer, Dorene PhD, RD; West, Daniel C. MD; Bale, James F. Jr. MD; Yu, Clifton E. MD; Noble, Elizabeth L.; Tse, Lisa L.; Srivastava, Rajendu MD, MPH, FRCPC; Landrigan, Christopher P. MD, MPH; Sectish, Theodore C. MD; Spector, Nancy D. MD; for the I-PASS Study Education Executive Committee

doi: 10.1097/ACM.0000000000000264
Articles

Patient handoffs are a key source of communication failures and adverse events in hospitals. Despite Accreditation Council for Graduate Medical Education requirements for residency training programs to provide formal handoff skills training and to monitor handoffs, well-established curricula and validated skills assessment tools are lacking. Developing a handoff curriculum is challenging because of the need for standardized processes and faculty development, cultural resistance to change, and diverse institution- and unit-level factors. In this article, the authors apply a logic model to describe the process they used from June 2010 to February 2014 to develop, implement, and disseminate an innovative, comprehensive handoff curriculum in pediatric residency training programs as a fundamental component of the multicenter Initiative for Innovation in Pediatric Education–Pediatric Research in Inpatient Settings Accelerating Safe Sign-outs (I-PASS) Study. They describe resources, activities, and outputs, and report preliminary learner outcomes using data from resident and faculty evaluations of the I-PASS Handoff Curriculum: 96% of residents and 97% of faculty agreed or strongly agreed that the curriculum promoted acquisition of relevant skills for patient care activities. They also share lessons learned that could be of value to others seeking to adopt a structured handoff curriculum or to develop large-scale curricular innovations that involve redesigning firmly established processes. These lessons include the importance of approaching curricular implementation as a transformational change effort, assembling a diverse team of junior and senior faculty to provide opportunities for mentoring and professional development, and linking the educational intervention with the direct measurement of patient outcomes.

Dr. Starmer is staff physician and lecturer in pediatrics, Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts. She is also volunteer affiliate professor, Department of Pediatrics, Oregon Health and Science University (OHSU) and OHSU Doernbecher Children’s Hospital, Portland, Oregon.

Dr. O’Toole is assistant professor, Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Dr. Rosenbluth is associate professor, Department of Pediatrics, University of California, San Francisco (UCSF), School of Medicine and UCSF Benioff Children’s Hospital, San Francisco, California.

Dr. Calaman is associate professor, Department of Pediatrics, Drexel University College of Medicine and St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania.

Dr. Balmer is associate professor, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.

Dr. West is professor, Department of Pediatrics, University of California, San Francisco (UCSF), School of Medicine and UCSF Benioff Children’s Hospital, San Francisco, California.

Dr. Bale is professor, Departments of Pediatrics and Neurology, University of Utah School of Medicine, Intermountain Healthcare, and Primary Children’s Hospital, Salt Lake City, Utah.

Dr. Yu is associate professor, Uniformed Health Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland.

Ms. Noble is I-PASS Study research coordinator, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts.

Ms. Tse is I-PASS Study research assistant, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts.

Dr. Srivastava is associate professor, Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, and Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah.

Dr. Landrigan is associate professor, Department of Medicine and Pediatrics, Harvard Medical School, and Department of Medicine, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, Massachusetts.

Dr. Sectish is professor of pediatrics, Harvard Medical School, and Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts.

Dr. Spector is professor of pediatrics, Department of Pediatrics, Drexel University College of Medicine and St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania.

Funding/Support: The I-PASS Study is primarily supported by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (1R18AE000029-01). The study was developed with input from the Initiative for Innovation in Pediatric Education and the Pediatric Research in Inpatient Settings (PRIS) Network (supported by the Children’s Hospital Association, the Academic Pediatric Association, the American Academy of Pediatrics, and the Society of Hospital Medicine). A.S. was supported by the Oregon Comparative Effectiveness Research K12 Program (Agency for Healthcare Research and Quality, 1K12HS019456-01). Additional funding for the I-PASS Study is provided by the Medical Research Foundation of Oregon, Physician Services Incorporated Foundation (of Ontario, Canada), and Pfizer (unrestricted medical education grant). Computer modules used in the I-PASS curriculum were developed by Concurrent Technologies Corporation.

Other disclosures: R.S. and C.L. are supported by the Children’s Hospital Association for their work as Executive Council members of the PRIS Network. C.L. has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for delivering lectures on sleep deprivation, physician performance, handoffs, and safety. The other authors declare no conflicts of interest.

Ethical approval: Ethical approval was granted by the Boston Children’s Hospital institutional review board, which served as the study’s coordinating center (protocol X10-08-0392, approved August 5, 2010). Additional approval was granted by the institutional review boards from each participating study site.

Disclaimer: The opinions and conclusions expressed herein are solely those of the authors and should not be construed as representing the opinions or policy of any agency of the U.S. government.

Previous presentations: The I-PASS Study Group has presented brief descriptions of the development of the curriculum in 48 national and international academic presentations. However, this comprehensive overview of the curriculum development process has not previously been presented or published.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A201.

Correspondence should be addressed to Dr. Starmer, Department of Medicine, Boston Children’s Hospital, HU 270.2, 300 Longwood Ave., Boston, MA 02115; telephone: (617) 355-0673; e-mail: amy.starmer@childrens.harvard.edu.

© 2014 by the Association of American Medical Colleges