One of the most critical and danger-prone periods for any hospital patient occurs during a shift change. Studies have shown that this “hand-off” period or shift change can be fraught with errors involving a lack of communication or miscommunication.
Boston Children’s Hospital has developed a program by which this danger period can become less dangerous and medical errors reduced 40%, according to physicians at the Pediatric Academic Societies annual meeting in Boston. Here’s how it works:
“The patient safety and medical education initiative standardizes patient handoffs during shift changes, according to the research announcement yesterday. In the I-PASS model, clinicians trained in communication and teamwork skills using the Agency for Healthcare Research and Quality-developed TeamSTEPPS use a mnemonic device to convene key information:
I — Illness severity
P — Patient summary
A — Action list for the next team
S — Situation awareness and contingency plans
S — Synthesis and “read-back” of the information
In addition, clinicians share a printed document during the handoff, integrated into the patient’s electronic medical record. The documents include significantly more information, including a to-do list for the patient and medication lists.
Other medical facilities are studying the process in anticipation of implementing it in their own facilities.
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