Standardized handoff improves ICU provider preparedness, reduces early morning order entry

A study, published in JAMA Surgery, examined whether the UW-IPASS standardized handoff affects clinician communication in the intensive care unit.

Researchers conducted a stepped-wedge randomized clinical trial at eight medical and surgical ICUs at two hospital systems between October 2015 and May 2016. Study participants included 63 residents and advance practice clinicians, 13 fellows and 30 attending physicians. The participants were involved in 1,488 handoff events over the study period.

The UW-IPASS standardized handoff is a resident-led quality improvement project in the ICUs. It standardized system of verbal hand-offs and written sign-out.

The study shows that prior to implementation of the UW-IPASS handoff, or control period, clinicians reported being unprepared for their shift because of a poor-quality handoff in 10.2 percent of 343 handoffs. Residents who were involved in the UW-IPASS handoff period, however, reported being unprepared in 7.2 percent of 740 handoffs.

Compared with the control period, the perceived duration of handoffs among clinicians using the UW-IPASS protocol remained unchanged. Additionally, early morning order entry decreased from 106 per 100 patient-days in the control phase to 78 per 100 patient-days in the UW-IPASS handoff period.

Researchers also found that UW-IPASS was not associated with any changes in ICU length of stay, duration of mechanical ventilation or the number of reintubations.

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