A unique I-PASS handoff document was created by a resident or APP for each postoperative or surgical consult patient immediately after surgery or on consultation using the EMR “SmartPhrase” template. All providers were notified that adherence would be assessed by way of written handoff monitoring throughout the study period. Providers were asked specifically to use the template for all postoperative patients or surgical consult patients belonging to the following services: orthopaedic trauma, hand, arthroplasty, spine, and foot and ankle. In May 2019, because of the ongoing COVID-19 pandemic, the intervention was initiated through a secure electronic correspondence notifying all orthopaedic surgery residents, fellows, and APPs to begin using the OrthoPass handoff tool. The purpose of this study was to adapt the I-PASS tool for orthopaedic surgery and then determine the effectiveness and sustainability of a handoff improvement intervention by assessing the objective quality of patient handoffs over time. Objective handoff quality and clinical outcomes were evaluated and compared before and after the intervention. We administered a needs assessment to identify deficiencies in the existing handoff system at two level 1 trauma centers and then performed a prospective I-PASS intervention for orthopaedic surgery. 1, 6 The adoption of I-PASS was previously shown to be less consistent in surgical fields than in medicine and pediatrics, 6 and its adaptation for orthopaedic surgery has not been previously described. 1 The I-PASS tool includes the following quality elements: Illness severity, Patient summary, Action list, Situational awareness, Synthesis by receiver. 8, 9 Rather than designing a new tool, we chose to adapt the I-PASS handoff template, which has been shown to decrease medical errors and preventable adverse events in nonorthopaedic surgery fields. Previous studies on orthopaedic surgery handoffs have described the development of handoff criteria de novo through surveys and focus groups. Moreover, duty-hour restrictions are estimated to have increased the number of patient handoffs by 130 to 200%, 2 and the handoff phase of care is known to be a time of high error and lost information. 5 Despite the increase in the number and complexity of patients on orthopaedic surgical services, 6 very few studies have examined the best practices for handoffs in orthopaedic surgery. In addition, many orthopaedic services have established geriatric comanagement services, resulting in more medically complex geriatric patients admitted to the orthopaedic service. 3Īs elective procedures continue to shift to high-volume hospitals, 4 orthopaedic surgery residents and advanced practice providers (APPs) are often tasked with providing perioperative care for complex trauma patients and elective surgery patients as part of one integrated orthopaedic surgery service line. 1, 2 The high volume of surgical patient care at many tertiary centers requires efficient and effective handoffs to minimize medical errors and optimize patient care. 2, 3 Interventions to improve and standardize communication during handoffs have been shown to reduce medical errors. 1 Transitions of patient care from one provider or team to another, also known as “handoffs,” are a risk factor for medical error. Studying for Step 3? Here's the most useful resources.Medical errors are a leading cause of death among Americans. UCSD Practical guide to clinical medicine
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