Background: Communication errors are a common root cause of medical errors. Prior inpatient studies have shown that standardization of patient hand-offs using tools such as I-PASS significantly decrease medical errors and preventable adverse events and remain time-efficient. However, there is limited evidence regarding the effectiveness of standardized sign-out tools in the emergency department (ED) setting. Our study examines the effect of implementing a standardized ED patient hand-off tool on sign-out duration and quality.
Methods: We designed a modified version of I-PASS for use specifically in the ED. The intervention consisted of a video curriculum for all providers at a single high-volume teaching hospital as well as reminder cards placed at all ED workstations. Change of shift hand-offs were directly observed for 7 weeks pre-intervention and 8 weeks post-intervention, measuring duration of sign-out and adherence to the I-PASS-based hand-off structure. We also gathered survey data pre- and post-intervention from resident and attending physicians evaluating provider impressions of the quality of patient care transfers. We retrospectively reviewed electronic medical record data for the pre- and post-intervention groups to evaluate ED length of stay, patient return to ED within 72 hours, in-hospital mortality, and number of inpatient patient safety events.
Results: Post-intervention compliance with the I-PASS-based hand-off method was 90.7% overall. The mean duration of time per patient spent on sign-out was 96 seconds (SD 42 seconds) in the pre-intervention group and 92 seconds (SD 26 seconds) in the post intervention group. There were no significant differences in ED length of stay, patient return to ED within 72 hours, in-hospital mortality, or number of patient safety events in the pre- and post-intervention groups. Residents felt that I-PASS somewhat improved both sign-out efficiency and quality while attendings felt that I-PASS did not affect sign-out quality or efficiency.
Conclusions: A video-based curriculum resulted in high adherence to I-PASS-based sign-out in the two months following this educational intervention. Using I-PASS-based patient hand-offs in the ED did not affect the time required for sign-out. Residents but not attendings thought I-PASS-based patient hand-offs moderately improved sign-out quality and efficiency.