All patients are seen by a paediatric emergency medicine (PEM) attending but also may be seen by medical students, paediatric residents, EM residents and PEM fellows. The main ED, where the project was implemented, consists of 25 beds including two resuscitation beds. This quality improvement (QI) initiative was implemented at a quaternary paediatric ED with a level I trauma centre, with an average ED yearly patient census of 80 000. Secondary aims were to decrease omissions of critical patient information and handoff miscommunications by 50%. Our aim was to improve the quality of handoffs during team sign-outs in the ED by establishing proper utilisation and compliance with a modified I-PASS handoff tool for 0%–80% in a 6-month period. Prior to our intervention, there was no standardised approach to patient handoffs in our paediatric ED, and there was great variability among providers. 21–23 While these studies showed that I-PASS may be feasible in the ED, there are no current reports of successful implementation. 12 21 However, the few studies evaluating the use of I-PASS specifically in the ED setting were performed qualitatively and focused on the feasibility of implementation. 19 20 Literature reviewing crucial elements for successful ED handoffs has been in line with key components of the I-PASS handoff tool. 18 The few studies that have evaluated the use of standardised checklists in the ED setting have shown reduced omission of key information and improved ED situational awareness without increasing time of check out. Among the programmes that did have a protocol, most of the residents did not use them regularly. 13 14 In a survey of 147 emergency medicine (EM) residency programme directors and academic EM faculty in 2011, over half indicated that their ED does not use a standardised handoff protocol. While the standardisation of handoffs has been a focus for inpatient settings, few studies have looked at this in the ED setting where shift changes often lead to multiple handoffs between providers with varying levels of training. 13–16 This tool, focusing on resident handoffs, has demonstrated improved patient safety in the inpatient setting.

10–12 Through a multicentre collaboration, the I-PASS handoff tool was developed based on materials adapted from TeamSTEPPS, the evidence-based medicine curriculum developed by the Agency for Healthcare Research and Quality and the Department of Defence Patient Safety Programme.

8 9 Since that time, the Quality Improvement and Patient Safety Section of the American College of Emergency Physicians as well as the American Academy of Pediatrics has identified the standardisation of handoffs as a target for improving patient safety in all settings including the emergency department (ED). 1–7 In 2006, The Joint Commission established a requirement to implement a standardised handoff approach. Miscommunications and omissions during handoffs are a leading cause of medical errors.

Ipass sign out