5 Effective Changes to Standardize Surgical Patient Hand-Offs

Effective hand-offs = safe patient care.

A coordinated, standardized, and clearly understood patient transfer isn’t always easy—but it’s essential. According to the Joint Commission, 67% of communication errors occur during patient hand-offs.

At the University of Texas MD Anderson Cancer Center in Houston, a multidisciplinary team—including physicians, advanced practice providers, physician assistants, trainees, nurses, safety engineers, operational experts, and healthcare educators—worked to standardize hand-offs across all inpatient areas using a systematic approach. They implemented I-Pass, a hospital-wide hand-off tool integrated into the system’s EHR.

I-PASS is a standardized verbal hand-off tool that has proved effective in reducing medical errors and increasing efficiency. I-PASS stands for five key elements in this hand-off process including: I-illness severity, P-patient summary, A-action list, S-situation awareness and contingency planning, and S-synthesis by receiver.

Thanks to a dedicated collaboration across departments, the consistent use of I-PASS surged from 41.6% to an 82.8% average utilization rate.

The team recently spoke with Periop Insider to share how I-PASS implementation worked successfully in surgical care.

Overcoming Barriers to Standardize Hand-Offs

Variability in hand-off practices between care teams was identified as a major culprit of ineffective hand-offs. To address this, the team engaged departments across the system and enlisted key champions to help overcome barriers and implement best practices collaboratively.

“Even those resistant to change were involved early on to learn from other teams how using I-PASS in our EHR system could improve workflows and save time during hand-offs,” the team said. 

Transitioning to I-PASS in surgery came with unique challenges, as many surgical teams had well-established hand-off practices in place. “Some surgical teams had a harder time transitioning from their existing hand-off format to using I-PASS in the EHR. Incorporating I-PASS elements into their hand-off checklist also proved challenging.”

Making Specific Improvements to Streamline Hand-Offs

To help teams adapt to using the standardized I-PASS in surgical care, the MD Anderson Hand-off Team made several process changes. Here are five that proved very effective:  

1. Surgical teams defined illness severity to help triage patients to the night team.
2. A new "Hand-off Specific Note" section was added to the I-PASS hand-off in the EHR to document team-specific information.
3. Smart texts were created to auto-populate existing chart information into I-PASS.
4. Specific times and locations were secured for surgical teams to conduct verbal hand-offs.
5. Surgical trainees held each other accountable for ensuring I-PASS completion.

Selling Hand-off Changes

Essential to their success, the MD Anderson Handoff Team secured I-PASS champions among senior leaders and sponsors within the institution. They did this with two key actions:

1. They highlighted real cases where inadequate or missed hand-offs negatively impacted patient care.
2. They shared data from initial pilots to demonstrate how other teams improved hand-off communication and saved time using I-PASS.

Read more about Enhancing Implementation of the I-PASS Handoff Tool Using a Provider Handoff Task Force at a Comprehensive Cancer Center in The Joint Commission Journal on Quality and Patient Safety.

Review evidence-based practices for the perioperative patient hand-off process in the AORN Guideline for Team Communication.