PC2057: Continuous Monitoring of the Implemented Electronic Medical Records (EMR) I-PASS Based Handover in ACGME-I Residency Program: Impact of COVID-19 Pandemic on the Compliance

Purpose/Objectives: COVID-19 Pandemic caused an unprecedented disruption in medical education and healthcare systems worldwide. EMR I-PASS based handover was a remarkable tool to overcome face to face handoff during the pandemic, however, this in itself lead to other challenges; how to provide an effective and yet comprehensive tool for this handover that might require focused user training.

Design/Methods: We aimed at constant monitoring every 3 months for the I-PASS EMR handover process with a goal of achieving > 60% completion of the elements in the American Academy of Pediatrics (AAP) guidance for written handover.

A cross sectional intervention study among the pediatric training program started in June 2019 using screening surveys for the patients’ medical records. It included multiple phases starting from PDSA cycle1(transfer from non-electronic to EMR handover) then PDSA cycle 2 (EMR during COVID-19). All the records were screened using the 15 elements of AAP guidance for written handover.

Results: Multiple phases obtained in (PDSA cycle 1) phase-1: Screening the non-EMR handover for patients using AAP guidance and hands-on training on I-PASS. Phase-2: Safe transitioning to I-PASS EMR handover for all patients over one month and phase-3: post-implementation evaluation the result came: successful 100% achievement transfer of 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 to 65%. In phase 2, new trainees joined the program, the average completion of the elements dropped down to 53%, which improved after refreshment courses of hands-on training to 73% and 70%. In PDSA cycle 2 average completion dropped to 43% In which multiple factors were identified; COVID-19 pandemic, new trainees, and new implemented pandemic on-call system. Four elements were deficient across the whole project: diet, recent vital sign, activity, and code status with average of 20%, 10 %, 3% and 3% respectively.

Conclusion/Discussion: The pandemic affected the healthcare system globally and its consequences was reflected on the training program.Many factors affected this project: Initially team work, excellent communication at all levels, and the continuous support from informatics education center and IT services led to initial success. However, the consistent monitoring of the EMR handover during pandemic showed regression in previous achieved percentages of completion and compliance. Implication; Our project shows that implanting EMR handover using I-PASS 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, however, the pandemic had a huge effect on the compliance, and this mandates future plans to include additional training for juniors and newly joined trainees using different methods.