Implementation and Evaluation of a Standardized Provider Handoff Tool, I-PASS, within a Cardiothoracic Surgical Intensive Care Unit

Abstract

Introduction and Purpose: Communication in healthcare is imperative to providing safe and effective care. Patients within the intensive care unit (ICU) are unique and complex, posing challenges in care. The Joint Commission on Accreditation of Healthcare Organizations (JACHO) 2020 national patient safety goals for hospitals is to improve the effectiveness of communication among healthcare providers. A level one urban hospital in the southeastern United States cardiothoracic surgical ICU lacks a structured, standardized handoff processes. Implementation and utilization of a standardized handoff communication process, I-PASS, within a cardiothoracic surgical ICU can improve communication failures and increase patient safety. Methods: The illness severity, patient summary, action list, situational awareness and contingency planning, and synthesis by the receiver (I-PASS) handoff communication tool was implemented among providers within a cardiothoracic surgical ICU over the course of a six-week period. Completion and compliance with both verbal and written communication were audited daily. A pre and post survey was conducted among provider participants which evaluated provider intent to change their handoff communication processes. Results: Six healthcare providers participated in the implementation of the I-PASS communication handoff tool within the cardiothoracic surgical ICU. 488 written provider handoffs were completed resulting in the mean illness severity inclusion of 97%, the mean patient summary inclusion of 99%, the mean action list inclusion of 99%, the mean situation awareness and contingency planning inclusion of 99%, and synthesis by the receiver was not DNP FINAL PROJECT 3 measured. 352 verbal provider handoffs were completed resulting in a mean illness severity inclusion of 96%, the mean patient summary inclusion of 91%, the mean action list inclusion of 100%, the mean situation awareness and contingency planning inclusion of 98%, and synthesis by the receiver of 94%. 11 questions in the CPD survey measuring the healthcare provider’s clinical behavior’s pre and post project implementation of the intervention tool, I-PASS, resulted in intention to utilize the tool, identified the I-PASS as a useful and beneficial tool, providers intending to change their handoff process. Discussion: Similar to findings in the literature, the outcomes of this PI project showed an increase in handoff completeness post intervention. Measurement of healthcare provider’s clinical behavior’s intent has not been previously analyzed with the I-PASS handoff. Limitations of the study included a small participant sample size, lack of I-PASS completeness prior to tool implementation, and limited staffing. Implementing practice change with the use of the I-PASS tool and conducting further projects/studies has the potential to improve patient outcomes by improving communication failures, decreasing length of stay, improving healthcare costs, and increasing patient safety.