Rationale / Evidence in Brief - Standardized Processes

A key element of the Joint Commission’s 8 tips for high-quality handoffs is to standardize tools and methods used to communicate to receivers.1 Use of tools such as computer-based sign-out procedures have been shown to reduce the risk of preventable AEs.9

Similarly, medical errors, preventable AEs, and near misses have been shown to decrease with the use of handoff bundles, such as I-PASS (Illness severity; Patient summary; Action list; Situation awareness and contingency planning; Synthesis by receiver).33

I-PASS is a multi-faceted handoff program that applies a structured approach to communication for patient transitions. When implemented at 9 medical centers over the course of 10,740 patient admissions, it reduced preventable AEs by 30% and medical errors by 23%.33 Since the original study, it has been adopted by more than 50 hospitals.8

Leonard and colleagues developed the SBAR (Situation, Background, Assessment, Recommendation) tool, which has been suggested to be useful in nurse-to-doctor and doctor-to-doctor communication, particularly when seeking assistance in an emergency from a provider who may be sleeping and/or off-site.34,35

Standardization of the methods and tools used to communicate information addresses one of the common criticisms of handoffs—that they are time consuming and full of irrelevant information.36

Though tools like I-PASS were originally designed for pediatric residency programs and were embedded in inpatient non-ICU pediatric services, they have been successfully adapted to large level III and IV NICUs including residents, fellows, and neonatal nurse practitioners.14,15