332 - Improving Handoff Efficiency Among Frontline Pediatric Hospitalists

Poster Number: 332
Publication Number: 332.323

Angie Alegria, Children's Hospital Los Angeles, Los angeles, CA, United States; Dina Jabaji, Children’s hospital los angeles, Los Angeles, CA, United States; Avni Shah, Children's Hospital Los Angeles, Los Angeles, CA, United States; Natalia V. Lotz, University of Southern California, Los Angeles, CA, United States; Kira Molas-Torreblanca, Children's Hospital Los Angeles, Los Angeles, CA, United States; Grant Christman, USC Keck School of Medicine / Children's Hospital Los Angeles, Los Angeles, CA, United States; Namrata Ahuja, Children's Hospital Los Angeles, Los Angeles, CA, United States; Joyce Koh, Children's Hospital Los Angeles, Manhattan Beach, CA, United States

Background:
Efficient high-quality handoffs can improve the work-life of clinicians.  Standardization of verbal handoff using I-PASS (illness severity, patient summary, action list, situational awareness/contingencies, and synthesis by receiver) improves patient safety among trainees. Less is known regarding I-PASS and handoff efficiency among hospitalists with medically complex patients.

Objective:
To increase the percentage of evening hospitalist handoffs completed by goal time from 54% to 75%.

Design/Methods:
This quality improvement project takes place at a tertiary care children’s hospital on teams with hospitalists as front-line physicians. The patients are both general pediatrics and complex subspecialty, including cardiology, pulmonology, surgical, and liver transplant patients. Our primary outcome measure was completion of verbal handoff by goal time (25 minutes per service). Hospitalists completed audit surveys at the end of handoff via a quick response (QR) code. The daytime hospitalists reported team census and handoff completion time. Root causes for inefficient handoff were identified in a fishbone diagram. The first intervention focused on standardizing verbal handoff using I-PASS with an educational presentation, badge buddies, and an electronic medical record written handoff tool. Using a separate audit survey, night shift hospitalists evaluated the frequency of 4 I-PASS elements (excluded synthesis) verbally identified by the daytime hospitalist. Compliance was defined as the use of the 4 I-PASS elements for >75% of patients (process measure). Run charts, bivariate analysis and logistic regression were used for analysis.

Results: A total of 298 daytime surveys and 194 nighttime surveys were completed from February to November of 2021. An average of 9.3 (23%) daytime hospitalists and 6.7 (31%) nighttime hospitalists per week responded. A total of 70 handoffs were captured, wherein both the day and night hospitalist surveys were completed for a given handoff. The average census was 8. Our run chart showed no improvement in percentage of handoffs completed by goal time with the first intervention. However, after accounting for census, using the 4 I-PASS elements >75% of the time was associated with 4 times the odds of handoff completion by goal time (OR 4.09, 95% CI 1.42-11.80). Conclusion(s):
Among frontline pediatric hospitalists caring for medically complex patients, adherence to I-PASS was associated with verbal handoff completion by goal time.  This finding may be an incentive for further I-PASS adoption. We will continue to address further barriers for completing timely handoffs in this project.

CVAlegria_CV_2021.pdf
Figure 2: Run ChartSlide1.jpegRun chart of hospitalist verbal handoffs completed by goal time (within 25 minutes) over time.