Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study.
Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study.
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在不同临床环境中实施 I-PASS 交接计划：一项多中心前瞻性有效性实施研究。
DOI：
10.1002/jhm.12979
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发表时间：
2023
影响因子：
2.6
通讯作者：
中科院分区：
文献类型：
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作者：
Starmer,AmyJ;Spector,NancyD;O'Toole,JenniferK;Bismilla,Zia;Calaman,Sharon;Campos,Maria-Lucia;Coffey,Maitreya;Destino,LaurenA;Everhart,JenniferL;Goldstein,Jenna;Graham,DionneA;Hepps,JenniferH;Howell,EricE;Kuzma,Nicholas;
背景切换错误通信是医疗差错的主要来源。实施I-PASS移交改进计划后，儿科学术医院的有害医疗差错减少了。目的确定跨不同环境实施I-PASS是否与患者安全和沟通的改善有关。设计前瞻性第二类混合有效性实施研究。环境和参与者来自32家医院不同专科的居民(12个社区，20个学术)。干预外部团队提供超过18个月的纵向指导，以促进增强的I-PASS计划和每月指标审查的实施。主要结果和措施系统监测调查评估了居民报告的不良事件的发生率。有效的直接观察工具测量口头和书面移交质量。结果来自多个专业的2735名住院医师和760名教职冠军(内科16名，儿科13名，其他3名)参与。共收集了1942份差错监测报告。实施后，与移交相关的重大和次要事件报告的不良事件减少了47%，从1.7%降至0.9%/人年(p<； .05)，17.5%降至9.3%/人年(p<； .001)。实施与在口头(20%对66%，p<； .001，n= 4812)和书面(10%对74%，p<； .001，n= 1787)移交中增加所有五个关键移交数据元素，以及增加高质量口头(39%对81%p<； .001)和书面(29%对78%，p<； .001)患者摘要、口头(29%对78%，p<； .001)和书面(24%对73%，p<； .001)应急计划，以及口头接收者综合(31%对83%，p<； .001)。在提供者类型(成人与儿童)和环境(社区与学术)之间的改善是相似的。
BackgroundHandoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I‐PASS handoff improvement program. However, implementation across specialties has not been assessed.ObjectiveTo determine if I‐PASS implementation across diverse settings would be associated with improvements in patient safety and communication.DesignProspective Type 2 Hybrid effectiveness implementation study.Settings and ParticipantsResidents from diverse specialties across 32 hospitals (12 community, 20 academic).InterventionExternal teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I‐PASS program and monthly metric reviews.Main Outcome and MeasuresSystematic surveillance surveys assessed rates of resident‐reported adverse events. Validated direct observation tools measured verbal and written handoff quality.Results2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff‐related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person‐year (p< .05) and 17.5 to 9.3 minor events/person‐year (p< .001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%,p< .001,n= 4812) and written (10% vs. 74%,p< .001,n= 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81%p< .001) and written (29% vs. 78%,p< .001) patient summaries, verbal (29% vs. 78%,p< .001) and written (24% vs. 73%,p< .001) contingency plans, and verbal receiver syntheses (31% vs. 83%,p< .001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).