I-PASS Handoff Curriculum: Core Resident Workshop

Instructor’s Guide

Nancy D. Spector,* Amy J. Starmer,* Clifton E. Yu, Jennifer K. O’Toole, April D. Allen, Lisa Tse, James F. Bale, Zia Bismilla, Sharon Calaman, Maitreya Coffey, F. Sessions Cole, Lauren Destino, Jennifer Everhart, JenniferHepps, Madelyn Kahana, Joseph O. Lopreiato, Robert S. McGregor, Shilpa J. Patel, Glenn Rosenbluth, Rajendu Srivastava, Adam Stevenson, Daniel C. West, Christopher P. Landrigan,† and Theodore C. Sectish† [*Co-first author; †Co-last author]

Overview of the I-PASS Handoff Curriculum Collection

Purpose

Communication failure is the leading root cause of sentinel events in hospitals. The increase in the number of handoffs related to new duty hour standards in teaching hospitals creates additional opportunities for communication failure. The lack of standardized handoff processes in North American teaching hospitals prompted the I-PASS Study Group to create this curriculum as the educational intervention in a multi-site research study aimed at reducing medical errors and standardizing the handoff process in 10 pediatric residency programs across North America.

The I-PASS Handoff Curriculum Collection was created by a group of pediatric educators, health services researchers, and hospitalists to teach a standardized approach to handoffs in inpatient settings. This collection is a comprehensive, evidence-based, and consensus-driven suite of educational materials created for a multi-site study that consists of six major complimentary components:

·  I-PASS Handoff Curriculum: Core Resident Workshop, a 2-hour didactic and interactive session that teaches I-PASS techniques and concepts

·  I-PASS Handoff Curriculum: Handoff Simulation Exercises, a 1-hour interactive role-play session to allow for practicing of techniques learned in the resident workshop or online module

·  I-PASS Handoff Curriculum: Online Module, an electronic tool that allows for independent learning and review of I-PASS concepts and techniques

·  I-PASS Handoff Curriculum: Campaign Toolkit, a collection of materials to ensure adoption and implementation of the I-PASS handoff process and change institutional culture

·  I-PASS Handoff Curriculum: Faculty Development Resources, a set of resources to educate and train faculty or handoff champions for the implementation of the I-PASS handoff program

·  I-PASS Handoff Curriculum: Faculty Observation Tools, a series of assessment tools designed to be used by institutions implementing the I-PASS handoff process

Implementation Plan

Because the handoff process has not been standardized and introducing the curriculum will require a transformational change in institutional culture, the effective use of these curricular materials requires a multi-pronged approach aimed at residents, faculty, and institutional culture.

A first step is to plan where and when I-PASS will be introduced. Within the Campaign Toolkit, you will find an Implementation Workbook that can help you through the planning process, and provide you with suggestions regarding how to accomplish the critical goal of engaging residents and faculty in initiating the change process. Within the Faculty Development Resources, a Faculty Champions Guide is included that provides further details.

A suggested sequence for teaching the I-PASS Handoff Curriculum to residents starts with the Core Resident Workshop and Handoff Simulation Exercises at a class-wide or residency-wide retreat. Reinforcement of knowledge occurs with the introduction of the Just in Time Didactic (found within the Campaign Toolkit) at the start of inpatient rotations. Instituting Faculty Observation Tools (including review of verbal handoffs and printed documents) and incorporating feedback to residents about the quality of handoffs reinforces knowledge and drives adoption of the new handoff process.

A suggested approach to teaching faculty begins with training faculty in I-PASS techniques at a faculty meeting (see presentation in Faculty Development Resources), or having faculty complete the Online Module as an alternative.

Participation in direct observations of residents with some frequency reinforces faculty knowledge and provides feedback to residents to improve the handoff process.

We suggest establishing an institutional campaign to drive culture change and sustain changes to the handoff process. Using the marketing and branding materials in the Campaign Toolkit reinforces I-PASS principles and supports faculty and other staff in championing this change effort. Additional educational efforts may need to be directed towards other providers such as nurses and medical students.

Goals of the I-PASS Handoff Curriculum for Residents

·  Understand the context of medical errors associated with communication failures

·  Introduce the TeamSTEPPSTM model of team training with an emphasis on leadership skills, training strategies, and communication skills in order to optimize team function

·  Learn the global elements of effective verbal and printed handoffs

·  Know the elements of an effective verbal handoff

·  Know the elements of an effective printed handoff document

·  Adopt the I-PASS mnemonic

·  Use high quality patient summaries to convey clinical information concisely and effectively in a handoff

·  Incorporate contingency planning in clinical care, especially in handoffs

Goals of the I-PASS Handoff Curriculum for Faculty

·  Understand the role of a faculty champion in the I-PASS handoff program

·  Learn and be able to use the I-PASS handoff technique

·  Understand the elements and organization of the Core Resident Workshop and Handoff Simulation Exercises

·  Introduce the faculty observation process for the I-PASS handoff program

For a comprehensive set of goals and objectives, as well as instructional resources and support materials, see the Curriculum Goals and Objectives for Residents included in the Core Resident Workshop and the Curriculum Goals and Objectives for Faculty in the Faculty Development Resources components.

Introduction to the Core Resident Workshop

The Core Resident Workshop is the centerpiece of the I-PASS Curriculum Collection. The workshop features a 2-hour didactic and interactive session devoted to team training in structured communication techniques and to the teaching of a standardized approach to the handoff process, including the integration of verbal and written handoff components. Key structured team communication techniques and the I-PASS mnemonic are taught in detail and reinforced with the use of trigger videos and large group discussion. Ideally this 2-hour session is followed by the 1-hour Handoff Simulation Exercises which features small group interactive role plays in which participants gain hands-on experience and practice the I-PASS handoff technique. This workshop is also suitable for a faculty educational retreat.

Resource Files

·  Curriculum Goals and Objectives for Residents (.doc)

·  Resident Workshop Slides (.ppt)

·  Resident Workshop Videos and Sounds (.zip)

·  Resident Workshop Interactive Guide for Participant (.doc)

·  Resident Workshop Interactive Guide for Facilitator (.doc)

·  Resident Workshop Participant Evaluation (.doc)

·  Resident Workshop Facilitator Evaluation (.doc)

The slide set includes speaker’s notes to guide discussion and a zip file contains all videos and sounds to be embedded in the presentation. The other documents are provided for distribution and use during the 2-hour presentation by participants and facilitators, respectively.

Objectives for the Core Resident Workshop

·  Describe the importance of effective communication in reducing medical errors

·  Apply effective team training strategies to improve handoffs

·  Detail the essential content and sequence of effective handoffs

·  Practice handoff skills

Implementation Strategies

A few practical tips for implementing the workshop:

·  Prior to the workshop, remind participants to do their learning styles inventory and bring the printout of their personal learning styles to the session. (http://www.engr.ncsu.edu/learningstyles/ilsweb.html)

·  Select speakers who have clinical expertise or interests in the topics covered in the 2-hour workshop and consider breaking up the 2-hour workshop among 2-3 speakers to create interaction and variety.

·  For the Handoff Simulation Exercises, one facilitator is needed for every three residents. Invite those facilitators to the 2-hour workshop.

·  For additional implementation strategies, see the Faculty Champions Guide in the Faculty Development Resources

Experience and Limitations

Residents’ responses have been extremely positive in multiple sites where this Core Resident Workshop has been delivered. Evaluations from 7 participating study sites representing 485 resident physicians demonstrated that after participating in the workshop, extremely high numbers of residents agree that they are able to describe the relationship between situation monitoring, situation awareness, and the development of a shared mental model (96%), list the circumstances in which one would utilize briefs, huddles, and debriefs (95%), recite and describe the individual elements of the IPASS mnemonic (91%), compare and contrast the differences of a verbal handoff and a written handoff document (94%), articulate the features of a high quality patient summary (97%), and describe the importance of using contingency plans in verbal and written handoffs (99%). Additionally, 97% of the resident physicians agreed that the workshop provided knowledge and skills relevant to patient care activities.

In some settings, identifying a 3-hour block of time that all residents can attend is challenging. If necessary, the Core Resident Workshop and Handoff Simulations Exercises can be divided into two sessions. Ideally, they are presented together.

References and Resources

1.  "Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Tools and Materials." http://www.ahrq.gov/. N.p., n.d. Web. 6 Feb 2012. http://teamstepps.ahrq.gov/abouttoolsmaterials.htm.

2.  Bordage, G. "Prototypes and Semantic Qualifiers: From Past to Present." Medical Education. 41.12 (2007): 1117-21.

3.  Cohen, M.D., and Hilligoss, P.B. "The Published Literature on Handoffs in Hospitals: Deficiencies Identified in an Extensive Review. " Quality and Safety in Health Care. 19.6 (2010): 493-497.

4.  Kaplan, D.M. "Perspective: Whither the Problem List? Organ-Based Documentation and Deficient Synthesis by Medical Trainees." Academic Medicine. 85.10 (2010): 1578-1582.

5.  Solomon, B. A., and Felder, R.M. "Index of Learning Styles Questionnaire." North Carolina State University. N.p., 2011. Web. 6 Feb 2012. http://www.engr.ncsu.edu/learningstyles/ilsweb.html.

6.  Starmer, A.J., Spector, N.D., Srivastava, R., Allen, A.D., Landrigan, C.P., Sectish, T.C. et al. "I-PASS, a Mnemonic to Standardize Verbal Handoffs." Pediatrics. 129.2 (2012): 201-204.

7.  Starmer, A.J., Sectish, T.C., Simon, D., and Landrigan, C.P. "Impact of a Resident Handoff Bundle on Medical Error Rates and Written Handoff Miscommunications." Pediatric Academic Societies Annual Meeting. Denver, CO. 2011.