Interunit Implementation of a Standardized Nurse Handoff Method in Cardiac Surgery

Abstract

Background: Handoff is inevitable and creates the potential for error or injury. Communication errors have been associated with hundreds of patient deaths and upwards of one billion dollars in cost annually. A method accounting for illness severity, patient summary, action list, situational awareness and contingency plans, and synthesis by receiver, called I-PASS, was developed to provide a handoff framework resulting in improved communication, reduced errors, and improved patient safety. Local Problem: The cardiac surgery patient population ranges in complexity from routine procedures to those who requiring some of the most complex procedures and management. There was no standard in place at this institution for nurse handoff of patients between the Cardiac Surgery Intensive Care and Telemetry units. Interventions: The I-PASS method was implemented at a tertiary academic medical center, over 13 weeks, to evaluate the effects on the nurse satisfaction, quality, handoff duration, and usability during nurse handoff between the Cardiac Surgery Intensive Care Unit and Telemetry units. This quality improvement project utilized the Plan-Do-Study-Act framework and included patients selected for unit transfer pre or post-intervention. Exclusion criteria included rapid response or emergent patient transfer. The I-PASS method was adapted for cardiac surgery. Staff education occurred during huddles. A resource sheet, modified system usability score and nurse satisfaction surveys were distributed to transferring and receiving nurses. Surveys were collected from each nurse and handoff duration documented. Results: The I-PASS method was liked by 39.5% of nurses. I-PASS reduced unnecessary or erroneous information reported by 41.7% of nurses. Longer handoff duration was perceived by 41.7% of nurses. I-PASS averaged a mean usability score of 59.36 and a mean handoff duration of 11 minutes. Conclusions: The current I-PASS method cannot be recommended. Modifications should be made to the nurse handoff method. Additional studies are recommended to further evaluate the impact of the I-PASS method during nurse handoff.