P0019 - Implementing Electronic Medical Record (EMR) I-PASS Based Handover: A Method to Improve the Hand-off Process in an ACGME-I Residency Program

Background: EMR has revolutionized the way medical care providers interact with the patients and their medical records. This in itself has provided another challenge; how to provide an effective and yet comprehensive tool for handover of these patients. I-PASS arises as a useful tool that can be used to improve the accuracy of the handoff information with special focus on the anticipated problems and the contingency planning for these patients.

Aim Statement: We aimed at transferring > 90 % of the pediatric inpatients’ written handover from non-electronic method to an electronic one over 2 month’s period using I-PASS format with a goal to achieve > 60 % of the elements in the AAP guidance for written handover.

Methodology: A cross sectional intervention study among the pediatric training program at Sidra Medicine started in June 2019 using subjective and objective measures. It included multiple phases starting with studying the perception of the trainees for non EMR to the EMR handover, then actual transfer of the handover into EMR based I-PASS using PDSA cycles. All the records of were screened before and after using IPASS handover using the 15 elements of AAP guidance for written handover. Post-implementation data were obtained.

Results: We were able to achieve 100% of the pediatric inpatients’ written handover from non-electronic method to an electronic one over 2 month’s period. The average completion of the 15 elements AAP guidance of handover in phase 1 was 56% which improved after piloting in 2 pediatric teams to 65%. In phase 2, new trainees joined the program, the average completion of the elements dropped down to 53%, which improved after refreshment course of hands-on training to 73% and 70% (figure-1). There were 4 elements that were deficient across the whole project: diet, recent vital sign, activity and code status with average of 20%, 10 %, 3% and 3% respectively( figure 2).

Discussion: Safe transition to EMR based handover was completed successfully in 2 months. Many factors affected the success of this project: team work and excellent communication at all levels; continuous support from informatics education center and IT services; and consistent monitoring for the EMR handover from chief office with leaders support in all action plans.

Conclusions: Our project shows that implanting EMR handover using IPASS can be achieved safely over 2 month-period with appropriate planning and follow up monitoring. It represents an excellent and safe tool to decrease human error in the hospital setting and ensure patients safety. Future plans includes more training for the juniors and the newly joined trainee using different methods like electronic learning modules. Frequent courses are needed to improve the AAP elements handover completion.