FACULTY CHAMPIONS GUIDE

VERSION 2.0

CONTRIBUTORS:
I-PASS Study Group
Editors: Jennifer K. O’Toole, MD and Nancy D. Spector, MD

I-PASS Education Executive Committee (EEC) Faculty Development Subcommittee: Jennifer K. O’Toole (co-chair), Nancy D. Spector MD (co-chair), April D. Allen, MPA, MA, Glenn Rosenbluth MD, Theodore C. Sectish MD, Amy J. Starmer MD, MPH, Daniel C. West, Clifton E. Yu MD

I-PASS Study Leadership:

I-PASS Study PI: Christopher P. Landrigan MD, MPH

I-PASS Project Leader: Amy J. Starmer MD, MPH

I-PASS Coordinating Council: April D. Allen MPA, MA, Jaime Blank CCRP, Christopher P. Landrigan MD, MPH, Theodore C. Sectish MD, Nancy D. Spector MD, Rajendu Srivastava MD, MPH, Amy J. Starmer MD, MPH

Membership of Additional I-PASS Committees Include:

I-PASS Education Executive Committee (EEC) Co-chairs: Nancy D. Spector MD, Amy J. Starmer MD, MPH

I-PASS EEC: April D. Allen MPA, MA, James F. Bale Jr. MD, Sharon Calaman MD, Maitreya Coffey MD, F. Sessions Cole MD, Lauren Destino MD, Jennifer Everhart MD, Jennifer Hepps MD, Madelyn Kahana MD, Christopher P. Landrigan MD, MPH, Joseph O. Lopreiato MD, Jennifer K. O’Toole MD, Shilpa J. Patel MD, Glenn Rosenbluth MD, Theodore C. Sectish MD, Nancy D. Spector MD, Amy J. Starmer MD, MPH, Adam Stevenson MD, Daniel C. West MD, Clifton E. Yu MD

I-PASS EEC Campaign Subcommittee: Glenn Rosenbluth MD (chair), April D. Allen MPH, MA, Sharon Calaman MD, Lauren Destino MD, Jennifer Everhart MD, Jennifer Hepps MD, Christopher P.Landrigan MD, MPH, Jennifer K. O’Toole MD, Shilpa J. Patel MD, Theodore C. Sectish MD, Nancy D. Spector MD, Amy J. Starmer MD, MPH, Adam Stevenson, Clifton F. Yu MD

I-PASS EEC Simulation Subcommittee: Sharon Calaman, MD (chair), Jennifer Hepps MD, Joseph O.Lopreiato MD, MPH, Robert McGregor MD, Clifton E. Yu MD

I-PASS Scientific Oversight Committee: Christopher P. Landrigan MD, MPH, Sanjay Mahant MD, MSc, Theodore C. Sectish MD, Nancy D. Spector MD, Rajendu Srivastava MD, MPH, Amy J. Starmer MD, MPH, Karen M. Wilson, MD, MPH, Daniel C. West, MD

Participating I-PASS institutions include:

Children’s Hospital Boston / Harvard Medical School (Coordinating Site)

Brigham and Women’s Hospital / Harvard Medical School (Data Coordinating Center)

Benioff Children’s Hospital / University of California San Francisco School of Medicine

Cincinnati Children’s Hospital Medical Center / University of Cincinnati College of Medicine

Doernbecher Children’s Hospital / Oregon Health & Science University School of Medicine

Hospital for Sick Children / University of Toronto

Lucile Packard Children’s Hospital / Stanford University School of Medicine

National Capital Consortium / Uniformed Services University of the Health Sciences

Primary Children’s Medical Center / Intermountain Healthcare / University of Utah School of Medicine

St. Louis Children’s Hospital / Washington University School of Medicine

St. Christopher’s Hospital for Children / Drexel University College of Medicine

Funding and Resources:

The I-PASS project is supported by Grant Number R18AE000029 from the U.S. Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health and Human Services.

The Pediatric Research in Inpatient Settings (PRIS) Network and the Initiative for Innovation in Pediatrics Education (IIPE) contributed to the management and oversight of the I-PASS Study.

Permissions:

The PRIS logo is used with permission from the Pediatric Research in Inpatient Settings Network.
The IIPE logo is used with permission from the Initiative for Innovation in Pediatric Education.

Some content in the I-PASS Handoff Study Curriculum includes materials adapted from TeamSTEPPSTM, an evidence-based teamwork curriculum developed by the Agency for Healthcare Research and Quality. All materials are used with permission.

FACULTY CHAMPION GUIDETABLE OF CONTENTS

  1. IntroductionPage 4
  2. IntroductionPage4
  3. I-PASS Handoff ProgramPage4
  4. I-PASS Resident Handoff CurriculumPage 4
  5. Faculty Opportunities to be involved with the I-PASS Handoff ProgramPage4
  1. Instructions for I-PASS Workshop Leader/FacilitatorPage 5
  2. Preparation for 2-hour WorkshopPage 5
  3. Preparation for 1-hour Role PlayPage 6
  4. Talking Points for Next StepsPage 7
  1. Instructions for I-PASS Handoff Simulation Small Group FacilitatorsPage 7
  2. General InstructionsPage 7
  3. Facilitation Instructions for I-PASS Handoff Simulation Role Plays Page 8
  4. Detailed Instructions for Facilitating I-PASS Role PlaysPage8
  1. Guidelines for Faculty Observation of Resident HandoffsPage 10
  2. Goals for faculty observation and evaluation of resident handoffsPage 10
  3. Guidelines for observation of residents on the I-PASS study teamsPage 10
  4. How to Use the I-PASS Direct Observation FormPage 11
  1. Guidelines for the I-PASS CampaignPage 14
  2. Just-in-time ModulesPage 14
  3. “Tips of the Day”Page 14
  4. Medical StudentsPage 15
  5. Visual AdvertisingPage 15
  6. Tracking/AdherencePage15
  1. Implementation Strategies for I-PASS Study SitesPage 16
  2. Overview – Implementation WorkbookPage 16
  3. General Principles for Implementation of the I-PASS WorkshopPage16
  4. I-PASS Online ModulePage 16
  5. Just-in-Time Module ImplementationPage17
  6. Faculty Development ImplementationPage 17
  1. Faculty Recognition for Participation in I-PASSPage18
  2. Quality Improvement OpportunitiesPage18
  1. CV AttestationPage18
  1. I-PASS Glossary of TermsPage 18
  2. Appendix A: Printed Materials Checklist for Resident WorkshopPage 19
  3. Appendix B: Printed Materials Checklist for Faculty WorkshopPage 19
  4. Appendix C: I-PASS Curriculum Implementation LogPage 20

  1. Introduction

Welcome Faculty! We are delighted you elected to participate in guiding the residents through the adoption of the I-PASS Handoff Program at your institution. This innovative educationalproject has the opportunity to not only to shape resident education at your institution, but also to improve the care provided to patients by ensuring safe transitions in care. Thank you for electingto participate in this exciting endeavor!

The I-PASS Handoff Program

The I-PASS Study(I-PASS = IIPE-PRIS Accelerating Safe Signouts Study) premiered in 2010 when investigators from Children’s Hospital Boston, in coordination with nine other pediatric research hospitals and residency programs in theUnited States and Canadaembarked on a studyto develop and evaluate anintervention to improve handoffs of care between resident physicians. Handoffs of carebetween medical providers have been identified as a major point of vulnerability to seriousmedical errors. Although handoffs are increasingly frequent in academic medicine,standardized handoff programs are infrequent and most residency programs do notprovide formal training in handoff skills.

The I-PASS Handoff Program is a multifaceted, all-inclusive suite of materials that will allow individuals in residency and hospital leadership to deploy an effective handoff program at their institution. The I-PASS Resident Handoff Curriculum contains all of the needededucational materials to implement an effective Resident Handoff Bundle (RHB) in a residency program. The I-PASS RHB is comprised of redesigned verbal and written handoff processes (including an innovative handoff mnemonic that promotes illness severity identification, situation awareness, and contingency planning),as well as team communication training. To complement the RHB, the I-PASS Handoff Program also includes various training materials to develop faculty champions who can become experts in these handoff and communication techniques, and therefore able to lead the training of residents providing effective feedback on their handoff skills. In addition, the I-PASS Handoff Program includes information and tools on: (1)how to implement the complete program in both small and large residency programs; (2) how to generate resident, faculty and institutional support for the project through innovative campaign techniques; (3) how to successfully sustain the program; (4) and how to incorporate other learners and healthcare professionals in the process.

The I-PASS Resident Handoff Curriculum

The I-PASS curriculum is presented in a 3-hour workshop that consists of a 2-hour session of didactic and interactive exercises, followed by a 1-hour handoff simulation using role play exercises. There is an Interactive Guide to lead participants through the 2-hour session and separate packets for the 1-hour handoff simulation role play exercises. However, training does not end with the workshop! Following, the I-PASS Study Group has developed a structured plan to include faculty observation and feedback on expert developed and validated observation forms aiming to cultivate resident skill development over time. In addition, the Study Group has created “Just in Time” training that will serve as a refresher for residents on critical elements of the RHB periodically during implementation of the program.

Faculty Opportunities to be involved with I-PASS

A multitude of opportunities are available to allow faculty to be involved with training and mentoring residents in the I-PASS program. A few designated faculty at each institution, theworkshop leaders and facilitators, will be tasked with administering the 2-hour didactic session and leading the interactive exercises contained within. Following these sessions, the residents then move on to the 1-hour of handoff simulation exercises during which a 1:3 ratio of faculty to residentsisneeded to facilitate these sessions. These faculty are known as the handoff simulation small group facilitators. Finally, faculty are needed to observe residents during live handoffs following education and once I-PASS handoffs are actively being used within a program. These live handoff faculty observers will be responsible for not only observing residents in a handoff, but also for providing feedback via the I-PASS faculty observation form on the quality of the written and verbal handoff for both the resident giving and the resident receiving a handoff. Detailed instructions are provided following this introduction for all of these faculty roles.

  1. Instructions for I-PASS Workshop Leader/Facilitator

Preparation for 2-hour workshop

  1. Room Set-Up
  2. Prepare room setup with crescent seating at round banquet tables of 6-8 so that participants can direct their attention to the speaker and the slides.
  3. Have sound system be able to broadcast sound from computer for video clips embedded in PowerPoint presentation.
  4. Use lavaliere microphone if audience is large so that you may move about the room.
  5. Use remote slide advancer so that you are not stuck at the podium.
  6. Practice delivery and test projection of slides (LCD’s with waning light bulbs are sometimes inadequate to project certain video clips).
  7. Preparing for the Presentation
  8. Review notes associated with each slide (liner notes) and edit to fit your program’s culture and your presentation style.
  9. Please refer to the Interactive Guide for Faculty, which includes notes for setting up video clips, debriefing, and leading discussion after each interactive segment.
  10. Determine your program’s Next Steps (how you will launch the campaign, what units will participate, how reinforcement of the curriculum and observations will take place) for your program. This should be executed in conjunction with residency program leadership and your site’s I-PASS study team. Refer to Talking Points for Next Steps - (Page 5).
  11. Have handouts for interactive portions prepared and collated in advance. These may be done on colored paper assembled in a sequence that determines the roles of each participant – giver of handoff, receiver of handoff, observer of handoff. (Please refer to Appendix A: Printed Materials Checklist for ResidentWorkshop for information regarding materials for the workshop)
  12. Review the I-PASS Educational Module Timeline (Pages 6-7).
  13. Participant Action Items
  1. Prior to the workshop, each resident must complete his or her Learning StylesInventory which they can access at the following website: . Each resident must print a copy of their results and bring this copy to the retreat.
  2. Have participants complete the Participant Workshop Evaluation Form at the end of the 3-hour session and collect the forms.
  3. Have faculty facilitators complete the Facilitator Workshop Evaluation Form at the end of the 3-hour session and collect the forms. The information from these forms and the participant workshop evaluation forms will contain important feedback that will assist with the implementation of the I-PASS program at your institution.

Preparation for 1-hour Role Play

  1. Preparing the Faculty
  2. To most effectively execute the workshop, the faculty to resident ratio should be 1:3 to ensure that each small group during the role-plays has a faculty facilitator. Faculty should attend the 2-hour session to be familiar with the curriculum.
  3. Assign a timekeeper (faculty member, admin, or RA) to keep groups moving through role plays.
  4. Refer to the section III:Instructions for I-PASS Handoff Simulation Small Group Facilitators.

I-PASS Resident WorkshopTimeline

Slide(s) / Topic / Format / Time / Elapsed Time
1-4 / Introduction / Didactic / 2 min / 2:00
5-7 / Communication Failure / Didactic / 1.5 min / 3:30
8 / Communication Failure / Didactic / 30 sec / 4:00
9 / ACGME Requirements / Didactic / 30 sec / 4:30
10-12 / TeamSTEPPS / Didactic / 3 min / 7:30
13-14 / Shared Mental Model / Didactic / 1.5 min / 9:00
15-17 / Comm Techniques/Video Intro / Didactic / 1.5 min / 10:30
18-20 / Brief / Didactic / Video / 2 min / 12:30
21-23 / Debrief / Didactic / Video / 2 min / 14:30
24-26 / Huddle / Didactic / 2 min / 16:30
27 / Large Group Discussion / Interactive / 5 min / 21:30
28-29 / Video Intro / Didactic / 30 sec / 22:00
30-33 / Cross Monitoring and Feedback / Didactic / Video / 2 min / 24:00
34-36 / Advocacy and Assertion / Didactic / Video / 2 min / 26:00
37 / Large Group Discussion / Interactive / 3 min / 29:00
38-39 / Check-Back / Didactic / 30 sec / 29:30
40 / Check-Back / Didactic / 2 min / 31:30
41 / Handoffs / Didactic / 30 sec / 32:00
42-44 / Summary / Key Points / Didactic / 1.5 min / 33:30
45 / Shared mental Model Exercise / Interactive / 2.5 min / 36:00
46-47 / Handoffs / Global Elements / Didactic / 1 min / 37:00
48-49 / Learning Styles Exercise / Pair share/interview; report / 3 min / 40:00
50-52 / Verbal / Printed handoffs / Didactic / 1.5 min / 41:30
53 / Handoff Example (poor quality) / Video / 2 min / 43:30
54 / Large Group Discussion / Interactive / 2.5 min / 46:00
55-56 / Mnemonic / Didactic / 1 min / 47:00
57 / Summary / Didactic / 30 sec / 47:30
58-61 / Illness Severity / Didactic / 1.5 min / 49:00
62-73 / Patient Summary / Didactic / 5.5 min / 54:30
74-75 / Patient Summary Example / Video/Printed Tool(sickle-cell) / 3 min / 57:30
76-77 / Patient Summary Exercise 1 / Exercise: pneumonia / 10 min / 67:30
78 / Patient Summary Example / Video/Printed Tool (pneumonia) / 1.5 min / 69:00
79 / Large Group / Didactic / 1 min / 70:00
80-81 / Patient Summary Example 2 / Exercise: pneumonia update / 5 min / 75:00
82-85 / Semantic Qualifiers / Didactic / 4 min / 79:00
86 / Patient Summaries Key Points / Didactic / 30 sec / 79:30
87-89 / Action List / Didactic / 1.5 min / 81:00
90-95 / Situation Awareness and Contingency Planning / Didactic / 3 min / 84:00
96-97 / Video / Points of Emphasis / Video / Didactic / 2 min / 86:00
98 / Contingency Planning Exercise / Exercise: pair share / 3 min / 89:00
99 / Video: Contingency Planning / Video / 1 min / 90:00
100 / Contingency Planning Key Points / Didactic / 30 sec / 90:30
101-104 / Synthesis by Receiver / Didactic / 1.5 min / 92:00
105 / Summary of Mnemonic / Didactic / 30 sec / 92:30
106-107 / Introduction to Handoff Simulations / Didactic / 1 min / 93:30
108-109 / Overall Summary and Next Steps / Didactic / 1 min / 94:30
110-112 / Contributors and Acknowledgments / Didactic / 1 min / 95:30
Lg Group / Transition to Small Groups / Transition / 5 min / 100:30
Sm Group / Handoff Simulations / Interactive Session / 75 min / 176:30
End / Evaluation / Evaluation / 3.5 min / 180:00

Talking Points for Next Steps

At the conclusion of the I-PASS workshop the residency program director or I-PASS champion of the institution should wrap-up the session with the following take-home points for the residents:

  1. Handoff education is a process and will need to continue within multiple educational and clinical venues throughout the year.
  2. Faculty will observe the handoff process and provide feedback on both the verbal and written handoff on a regular basis.
  3. I-PASS campaign will be launched on the targeted unit(s).
  4. You can anticipate that the campaign will last at least 12-18 months before the culture has changed. The ACGME now requires residency programs to standardize and monitor the handoff process.
  5. IT support at the institution will incorporate the I-PASS mnemonic into the printed handoff documents.
  6. When possible, the printed handoff document will incorporate imported data from the electronic medical record (EMR). (Medication lists, problem lists, primary care physician).
  7. It is recommended that supervising residents update free-text fields (Patient Summary, To Do List, Situation Awareness and Contingency Planning) within these printed handoff documents.
  8. It is recommended that handoffs be done with interns and supervising residents as a group process. During the course of the year, you may encourage interns to lead the handoff process with supervising residents in attendance.
  9. Feel free to provide additional talking points, tailored to the institutional needs or culture.
  1. Instructions for I-PASS Handoff Simulation Small Group Facilitators

General Instructions

  1. During the 2-hour workshop presentation, please sit at a table with residents.
  2. Encourage active participation in all discussions
  3. Clarify questions from the residents
  4. Throughout the entire teaching session, please record any feedback you have on the Facilitator Workshop Evaluation Form. This feedback will be useful to the I-PASS team at your institution.
  5. During the final hour of the teaching session, residents will be doing the I-PASS Handoff Simulation Role Plays. Residents will be assigned to groups of three with a faculty facilitator. You will be facilitating one of these small groups of 3 for the entire session. See instructions below for facilitation of the I-PASS Handoff Simulation Role Plays.
  6. After the role plays are complete, one of the Program Directors will review Next Steps for the residents. See Talking Points for Next Steps for the Program Directors(Page 7).
  7. Adjourn the session after residents complete the Participant Workshop Evaluation Form.

Facilitation Instructions for I-PASS Handoff Simulation Role Plays

There are 4 role plays for this session. For each role play, there are 3 roles: a resident giving the handoff, a resident receiving the handoff, and an observer. Ideally there should be a faculty facilitator for each group of three residents. For the first three role plays, each resident will play each role once. Instructions for the fourth role play, Shared Mental Model, are on the front page of the Shared Mental Model Handoff Simulation packet.

  1. Assemble the group in a circle.
  2. Give each resident one packet. The order of the assigned roles is guided by the order of sheets in each packet. The residents should not change the order.
  3. Ten to fifteen minutes are allotted for each scenario (this includes time for performing the scenario and debriefing). All groups in the room should change scenarios at the same time.
  4. The resident role is identified at the top of the page for each scenario.
  5. Ask the residents to read all instructions carefully. In some roles, the residents will also have a copy of the printed handoff document.
  6. Residents are encouraged to act and embellish the role to make it realistic.
  7. When in the observer role, the observer will be asked to complete a Direct Observation Tool.
  8. In each scenario, there may be unique challenges to be acted out and overcome. Have the residents follow instructions for their roles. They should treat the patient information as real and handoff what they believe might be appropriate contingency plans.
  9. Encourage the residents to use the communication techniques learned today to achieve the best handoff possible.
  10. The residents are welcome to use the pocket card as a guide.
  11. For each role play, the faculty facilitator should:
  12. Complete the Direct Observation Tool.
  13. Facilitate the scenario debrief.

Detailed Instructions for Facilitating I-PASS Role Plays