The ACGME duty hour standards have led to an increased frequency of transitions of care, necessitating a need to improve communication skills to prevent adverse events related to handoffs. The ACGME also requires residency programs to provide training in communication and safe transitions of care. At UCSD we implemented the I-PASS handoff bundle, an evidence based, standardized approach to teaching and improving handoffs. The I-PASS handoff bundle includes a comprehensive handoff curriculum, a standardized printed tool with the I-PASS elements, and direct observation and feedback of resident physicians by faculty.
This study aims to evaluate residents’ satisfaction with handoff training received at UCSD, as well as satisfaction with their colleagues’ handoffs both before and after implementation of a standardized handoff curriculum.
This is a retrospective pre- and post-intervention cohort study. Pre-implementation email surveys were sent to all residents with questions aimed at understanding perceptions and satisfaction with handoffs. The majority of residents, including all incoming interns, then received training on all elements of the I-PASS bundle. Four months post-implementation, the same email survey was sent to residents to re-evaluate their satisfaction with handoffs. The surveys were compared to assess the impact of the I-PASS curriculum. Given that not all senior residents received training, our study focuses primarily on intern data. The post-implementation survey was separated into new interns and senior residents. 63 residents (55.8%) responded to the pre-implementation survey, 22 interns (51%) and 36 senior residents (59%) responded to the post-intervention survey. Resident knowledge of a standardized format for handoffs increased from 31% of all residents to 90% of new interns and 73% of senior residents. Prior to implementing the program, 73% of residents reported being observed as an intern, whereas afterwards 91% of new interns reported being observed. Before implementation, 20% of all residents were very satisfied with sign-out training; this improved to 68% of new interns post-intervention. Residents also reported a perceived decrease in overnight issues that were not included in sign-out, from 76% pre-intervention to 36% post-intervention. Finally, 45% of interns post-implementation reported being “very satisfied” with colleagues’ sign-out, as compared to 29% pre-implementation.
This study aimed to evaluate resident physician opinions before and after implementation of the standardized I-PASS handoff bundle. The data suggests the curriculum was effective in improving resident knowledge of a standardized handoff format, as well as in increasing the number of direct faculty observations of handoffs. Further, not only did resident satisfaction with handoff training improve, but there was also an increase in interns’ satisfaction with their colleagues’ handoffs. Overall, our survey indicated the I-PASS curriculum improved residents physicians’ satisfaction with the handoff training they receive at UCSD.