Electronic I-PASS: Updating the Handoff Safety Tool Through EHR Integration and Workflow Enhancement

Berlyand Y, Lee AH, Hasdianda MA, Baymon DM, Massarotti EM, Shannon EM, Hankinson EA, Cauley MR, Delaporta L, Goralnick E. Electronic I-PASS: Updating the Handoff Safety Tool Through EHR Integration and Workflow Enhancement. NEJM catalyst. 2023 Jan 18; 4(2):DOI: 10.1056/CAT.22.0346.

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Abstract:

Each ED-to-inpatient (IP) admission is accompanied by a high-risk event - the handoff. Historically, handoffs from the ED to the IP service were conducted verbally and were both unstructured and difficult to coordinate, often causing delays in transferring patients. I-PASS (a mnemonic for illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) is a tool that has shown promise in standardizing handoffs, but it remains underused. To improve timeliness while maintaining patient safety, Brigham and Women's Hospital implemented a novel use of eIPASS - an ED-to-IP I-PASS handoff tool in its electronic health record for both providers (attending physicians, resident physicians, and physician assistants) and nurses of patients admitted to a medical service (internal medicine, cardiology, and oncology). This tool facilitated standardization of handoff content and format, allowed providers the flexibility to complete as time allows, and was usually completed by the initial provider. Brigham and Women's Hospital found that implementation of eIPASS was achieved with 74% utilization among providers and 94% among nurses. Survey data showed that ED clinicians received fewer clarifying telephone calls (10% after 1 year vs. 51% at the start). Time elapsed between ready IP bed and ED departure did not differ significantly between encounters in which eIPASS was completed versus encounters in which it was not. The balance measure - the percentage of escalations to the ICU within 6 hours of ED-to-IP floor transfer - remained unchanged from baseline levels of 0.3% after eIPASS implementation. eIPASS was highly utilized upon implementation without compromising patient safety. As of July 2020, the optional-use eIPASS has become the primary method used for ED-to-IP handoff at Brigham and Women's Hospital and could be emulated at other institutions.