PC1221: Improving Handoff Efficiency Among Frontline Pediatric Hospitalists

Purpose/Objectives: Efficient high-quality handoffs can improve the work-life of clinicians. Standardization of verbal handoff using I-PASS (illness severity, patient summary, action list, situational awareness/contingencies, and synthesis by receiver) improves patient safety among trainees. Less is known regarding I-PASS and handoff efficiency among frontline hospitalists. Our specific aim was to increase the percentage of evening hospitalist handoffs completed by goal time from 54% to 75%.

Design/Methods: This quality improvement project takes place at a tertiary care children's hospital on teams with hospitalists as frontline physicians. The patients are general pediatrics and complex subspecialty. Our primary outcome measure was completion of verbal handoff by goal time (25 minutes per service). Hospitalists completed audit surveys at the end of handoff via a QR code. The daytime hospitalists reported team census and handoff completion time. Root causes for inefficient handoff were identified in a fishbone diagram (Figure 1). The first intervention focused on standardizing verbal handoff using I-PASS with an education presentation, badge buddies, and an electronic medical record written handoff tool. Using a separate audit survey, nocturnists evaluated the frequency of 4 I-PASS elements (excluded synthesis) verbally identified by the daytime hospitalist. Adherence was defined as the use of the 4 I-PASS elements for greater than 75% of patients (process measure). Run charts, bivariate analysis, and logistic regression were used for analysis.

Results: A total of 298 daytime surveys and 194 nighttime surveys were completed from February to November of 2021. An average of 9.3 (23%) daytime hospitalists and 6.7 (31%) nighttime hospitalists per week responded. Median I-PASS adherence was 50%, with illness severity being the least reported. A total of 70 matched handoffs were captured, wherein both the day and night hospitalist surveys were completed for a given handoff. The average census was 8. Our run chart showed no improvement in percentage of handoffs completed by goal time with the first intervention (Figure 2). However, after accounting for census, using the 4 I-PASS elements greater than 75% of the time was associated with 4 times the odds of handoff completion by goal time (OR 4.09, 95% CI 1.42-11.80).

Conclusion/Discussion: Among frontline pediatric hospitalists, adherence to I-PASS was associated with verbal handoff completion by goal time, which may be an incentive for further I-PASS adoption. Limitations for our study results include sampling bias (optional surveys) and recall bias for survey questions. Further barriers for completing timely handoffs need to be addressed in this project.