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As part of our aim to improve communication and patient safety (reduction in medical errors), we piloted and implemented a standardized approach to resident
handoffs on the inpatient units with the introduction of the
I-PASS handoff process. We employ a standard language
for our verbal handoffs to focus the discussion at evening
sign-out. Using our EMR, we developed an electronic
handoff tool that imports medical information
automatically and residents update text fields within the
electronic handoff tool to provide timely information about
illness severity, patient summary, action lists, situation
awareness and contingency plans to ensure a shared
mental model of the patients on the team between the
incoming and outgoing teams. A pilot study demonstrated
a 40% reduction in medical errors, a decrease of time at
the computer (roughly 30 minutes per day), and increased
time at the bedside (30 minutes per resident per day). On
the basis of these results, we are beginning to implement
the I-PASS handoff process across our program. More
information about the I-PASS study and the educational
curriculum is available at www.ipasshandoffstudy.com, on
the MedEdPORTAL (https://www.mededportal.org/
publication/9311, https://www.mededportal.org/
publication/9402, https://www.mededportal.org/
publication/9397), and in several publications: Sectish TC.
Pediatrics 2010;126:619-622, Starmer AJ. Pediatrics
2012;129:201-204, and O’Toole JK. J Peds 2013;162:
887-888.
We continue to refine our approach to improving duty hours within the BCRP and will monitor closely the impacts to education, patient care and continuity, resident workflow, patient safety, and work-life balance in the new inpatient team models. At the BCRP we pride ourselves in the rigorous approach we take to educational innovations and systems improvements.
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