During training, resident physicians must learn not only how to manage the care of their patients but also how to efficiently and safely transfer the patient into the care of another physician—a practice done in person, in writing or over the phone. Developing proficiency in verbal sign-outs, therefore, becomes an essential part of residency training, and the I-PASS handoff mnemonic can help.
During verbal sign-outs—often called “handoffs”—for shift changes, cross coverage and in emergencies, mnemonics help physicians remember the steps of a verbal sign-out that is rich with necessary information without overburdening the listener, which could cause reduced attention due to mental fatigue.
A strategy supported by science
Several mnemonic devices have been developed over the years to facilitate handoffs, but a growing body of research has shown the efficacy in diverse clinical settings and medical specialties of the I-PASS handoff mnemonic, which was first introduced in 2012 in the journal Pediatrics as a way of preventing miscommunication or incomplete communication in handoffs between physicians.
Here is what the I-PASS mnemonic stands for.
- Illness severity: Relay the patient’s illness severity level.
- Patient summary: Detail the events that led to the hospital admission, the illness course, the ongoing assessment and the current plan.
- Action list: Explain the to-do list, timeline and ownership.
- Situation awareness and contingency plan: Discuss what’s going on and the plan for what might happen.
- Synthesis by receiver: The receiver summarizes what was heard, asks any questions and restates the key action items or to-do list.
That Pediatrics article also offers a sample verbal handoff as an example of how to use the I-PASS mnemonic.
A follow-up study showed a reduction in both medical errors and preventable adverse patient events after the I-PASS mnemonic was introduced at a group of pediatric residency training programs in the U.S. and Canada.
Further support found for effectiveness
Research published last winter in the Journal of Graduate Medical Education found that after residents changed from the previous unstructured written handoff to verbal I-PASS handoffs, there were fewer adverse patient events during care transitions.
“The increasing fragmentation of the U.S. health care system over the past decade has made transitions in care a vulnerable time for hospitalized patients,” the study’s authors wrote. “These transitions are prone to miscommunications, prolonged hospitalizations, and adverse patient outcomes.”
The original I-PASS study was time- and resource-intensive, noted Anh Tuan Pham, MD, the study’s lead author. The more recent study showed a much shorter educational intervention could still reduce adverse patient events.
