# I-PASS-Based Handoff Pilot in a High-Volume Urban Hospital: Benefits and Barriers for Hospitalists

## TL;DR

This study explores the implementation of the I-PASS handoff protocol in a hospital, finding that while it raised awareness, it was not widely used due to practical challenges.

## Contribution

The study provides insights into the barriers to using I-PASS in hospital settings and suggests adaptations for better implementation.

## Key findings

- Participants felt the I-PASS-based tool was suboptimal but noted increased awareness of handoff processes.
- Most preferred existing electronic medical record tools for their efficiency and adequacy.
- Recommendations included standardizing formats and obtaining provider buy-in for successful implementation.

## Abstract

Background

The I-PASS bundle is a standardized care handoff associated with improved outcomes that is widely used in residency training. Sustainable use of I-PASS bundle components among attending hospital medicine providers merits further study. After we implemented a handoffs pilot process including written handoffs and Epic chat message (surrogate for verbal handoff) based on the I-PASS protocol, providers reported high levels of satisfaction. However, the pilot tool was utilized infrequently, and use ceased after the pilot.

Methodology

We utilized qualitative methods to assess attending physicians’ and Advanced Practice Providers’ perceptions to understand discrepancies between perceived utility and actual use. From February to March 2022, we interviewed 13 attending hospitalist physicians (n = 11) and Advanced Practice Providers (n = 2) individually or in homogenous focus groups; we transcribed recordings for qualitative coding (interrater agreement was κ = 0.82). We coded and analyzed the textual data via the specific concerns participants shared in the interviews and focus groups.

Results

Participants felt that while the I-PASS-based tool was suboptimal, the pilot raised overall awareness and use of handoff processes. They recommended that feasible handoff processes provide necessary information quickly for cross-cover providers, but do not require similar details for stable patients. Most participants reported that existing electronic medical record chat functions along with notes were adequate and more efficient. They also recommended standardizing format and processes; obtaining buy-in from all patient care providers; education on efficient use of tools; and formal, explicit expectations that providers complete handoffs.

Conclusions

Handoffs are an important component of patient safety measures. While they perceived the I-PASS-based tool to be suboptimal in several aspects, participants felt that the handoff quality improvement pilot raised overall awareness and use of handoff processes, which they felt was important for patient safety. Implementation of I-PASS bundle components may require contextual adaptation.