Implementation of a low-cost standardized handoff system (IPASS) in a pediatric hematology/oncology unit: Lessons from a low-middle income country.

Abstract

278 Background: Communication failure is the most common preventable cause of medical adverse event, and almost half of all sentinel events involve handoff failure. Inefficient handoff is labor intensive and time consuming, impacting the quality of patient care provided. A safe and efficient means of exchange of medical information between care teams via a standardized handoff system is essential, especially in high intensity fields such as Pediatric Hematology/Oncology. Methods: Pre-intervention, handoff entailed the physical handover of handwritten notes, carbon copied for various team members. A standardized electronic handoff tool (IPASS) was identified, and significantly modified to fit our needs, since we do not have a complete electronic medical record (EMR). Microsoft Sharepoint (Microsoft, Redmond, WA) was used to develop a tabulated online portal incorporating patient demographic, clinical and laboratory details with physician remarks. This allowed remote access, multiple simultaneous inputs, authenticated use and user-specific access control. Implementation included sensitizing residents to the IPASS template, hands-on training, weekly feedback from the residents, directly observed hand-off by the chief and/or senior resident. Following a four-week pilot this was expanded to other sub specialties, and a pre and post intervention survey was conducted to assess its impact. Results: Pre-implementation survey revealed 74% resident and 87% faculty dissatisfaction with the current handoff process. Weekly compliance audits after initial pilot demonstrated a 100% compliance. Post-Implementation results showed that the resident dissatisfaction has gone down to less than 5%. Conclusions: Implementation of an electronic handoff tool in the absence of an EMR with minimal resources is a major breakthrough and can be replicated in other low-resource settings. We successfully implemented IPASS without any added infrastructure cost. In the next phase of our project we will be measuring trends in reduction in medical errors since implementation.