![]() ![]() We reviewed only events reported by physicians in the department of family medicine and excluded medical events for which communication at transitions of care of care would not be a factor (eg, falls). Two physician reviewers further classified all medical errors into subtypes of medical errors related to communication: within family medicine (FM) service, between FM service and different services, between FM service and floor nurses, and at the institutional level (eg, medication reconciliation, paging system). We also evaluated residents’ reported levels of confidence and preparedness with Likert scale responses 1 to 5 (1=very unconfident or not at all helpful and 5=very confident or extremely helpful).įor patient outcomes, we measured total number of medical errors during the two survey collection periods, using the incidence/occurrence system in our institution. We evaluated the effectiveness of I-PASS implementation by comparing the pre- and postimplementation data including number of unexpected floor calls and medical errors. The sign-out template and survey are available on the STFM Resource Library. To increase the number of respondents, we used several approaches: setting a survey collection box in the on-call room for residents to reduce access barriers, sending a reminder as part of weekly emails from the program director to all residents, and sending additional reminders to residents prior to the on-call shift. Some nights, two residents completed surveys for the same shift. We asked night float residents to complete the anonymous questionnaire every night shift when possible. When night float residents had unexpected floor calls, they also quantified the contents under the following categories: pain, blood pressure, and others. We collected data via an anonymous survey completed by night float residents to quantify unexpected floor calls, and measure residents’ preparedness and confidence in responding to floor calls. We collected postimplementation data for 24 weeks from October 2019 through March 2020. All components of the resident handoff bundle were implemented at the end of September along with a follow-up session in November. Preimplementation data were collected for 27 weeks from April through September 2019. A one-page summary of sign-out template and I-PASS instructions was attached to the wall in the inpatient team staff room. After each session, we also sent a follow-up email with a summary of the training content. ![]() 12 The Institutional Quality Improvement Review Committee approved this study.įor the intervention, we introduced the I-PASS structure through two 20-minute didactic lectures and on-the-job training sessions in September and November 2019. ![]() We conducted an observational study with 29 family medicine residents in a family medicine residency training program at an urban hospital. 6 We hypothesized that a standardized handoff process for resident sign-out would (1) reduce preventable unexpected floor calls, (2) improve residents’ confidence to care for patients overnight through better handoffs, and (3) reduce preventable adverse events. 11 In a 2014 multicenter study, the I-PASS Handoff Bundle implementation was shown to reduce preventable adverse events. 6, 10 The I-PASS mnemonic provides a framework for patient handoff as follows: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver. We selected the I-PASS Handoff Bundle because it is the most validated method for handoffs. Our family medicine residency program did not have a standardized overnight sign-out process. ![]() 5 Residency programs in other subspecialties, including pediatrics and internal medicine, have implemented standardized transition-of-care processes for the inpatient setting, although assessment of these quality improvement measures remains ongoing and data from family medicine are lacking. 4 The Accreditation Council for Graduate Medical Education (ACGME) mandates resident training in effective transitions of patient care and emphasizes the importance of managing handoffs to comply with new recommendations for resident duty hours. Patient handoffs between residents have become more frequent because of duty hour restrictions. 2 For example, a 2009 systematic review found that omitted information and incorrect information were common at patient care handoff. 1 Ineffective or incomplete transitions of care can negatively impact both patients and physicians by contributing to potential miscommunication and errors, or by compromising resident confidence. Communication error is a leading cause for sentinel events. ![]()
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