Effect of Standardized Handoff Curriculum on Improved Clinician Preparedness in the Intensive Care Unit: A Stepped-Wedge Cluster Randomized Clinical Trial
Open accessAbstract
Importance: Clinician miscommunication contributes to an estimated 250 000 deaths in US hospitals per year. Efforts to standardize handoff communication may reduce errors and improve patient safety. Objective: To determine the effect of a standardized handoff curriculum, UW-IPASS, on interclinician communication and patient outcomes. Design, Setting, and Participants: This cluster randomized stepped-wedge randomized clinical trial was conducted from October 2015 to May 2016 at 8 medical and surgical intensive care units at 2 hospital systems within an academic tertiary referral center. Participants included residents, fellows, advance-practice clinicians, and attending physicians (n = 106 clinicians, with 1488 handoff events over 8 months) and data were collected from daily text message-based surveys and patient medical records. Exposures: The UW-IPASS standardized handoff curriculum. Main Outcomes and Measures: The primary aim was to assess the effect of the UW-IPASS handoff curriculum on perceived adequacy of interclinician communication. Patient days of mechanical ventilation, intensive care unit length of stay, reintubations within 24 hours, and order workflow patterns were also analyzed. Mixed-effects logistic regression was used to compute odds ratios and confidence intervals with adjustment for location, time period, and clinician. Results: A total of 63 residents and advance practice clinicians, 13 fellows, and 30 attending physicians participated in the study. During the control period, clinicians reported being unprepared for their shift because of a poor-quality handoff in 35 of 343 handoffs (10.2%), while UW-IPASS-period residents reported being unprepared in 53 of 740 handoffs (7.2%) (odds ratio, 0.19; 95% CI, 0.03-0.74; P = .03). Compared with the control phase, the perceived duration of handoffs among clinicians using UW-IPASS was unchanged (+5.5 minutes; 95% CI, 0.34-9.39; P = .30). Early morning order entry decreased from 106 per 100 patient-days in the control phase to 78 per 100 patient-days in the intervention period (-28 orders; 95% CI, -55 to -4; P = .04). Overall, UW-IPASS was not associated with any changes in intensive care unit length of stay, duration of mechanical ventilation, or the number of reintubations. Conclusions and Relevance: The UW-IPASS standardized handoff curriculum was perceived to improve intensive care provider preparedness and workflow. IPASS-based curricula represent an important step forward in communication standardization efforts and may help reduce communication errors and omissions. Trial Registration: isrctn.org Identifier: ISRCTN14209509.
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An updated meta-analysis found systemic corticosteroid to accelerate resolution of shock.
“An updated meta-analysis (480) found systemic corticosteroid to accelerate resolution of shock (MD, 1.52 days; 95% CI, 1. 71 to 1 32).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [480]
The Patient Outcomes section reports ICU length of stay, mechanical ventilation, and reintubation after a handoff-curriculum intervention, not shock resolution. Searches for systemic corticosteroids, shock resolution, and the reported 1.52-day difference found no passage addressing the claim in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredNo dose response benefit was seen in a prior systematic review and meta-analysis.
“No dose response benefit was seen in a prior systematic review and meta-analysis (480).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [480]
The Statistical Analysis and Data Presentation and Results sections describe a stepped-wedge clinical trial of ICU handoffs, not a systematic review or meta-analysis. Searches for “dose response benefit” and “systematic review and meta-analysis” found no passage reporting the claimed finding. (LLM, conf=0.74)
Experimental — accuracy not yet measuredA single RCT in 8 ICUs found no effect of a standardised handoff process on duration of mechanical ventilation, ICU length of stay, or duration of handover.
“A single RCT using a stepped-wedge design in 8 ICUs evaluated the impact of a standardised handoff process, finding no effect upon duration of mechanical ventilation, ICU length of stay or duration of handover [568].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [568]
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- Authors
- Parent, B., LaGrone, L. N., Albirair, M. T., Serina, P. T., Keller, J. M., Cuschieri, J., Addison, E. J., Choe, L., Delossantos, G. B., Gaskill, C. E., Moon, S. D., MacDonald, J. T., Stolzberg, M. J., Van Eaton, E. G., Zech, J. M., & Kritek, P. A.
- Affiliations
- University of Washington Medical Center (US)
- University of Washington (US)
- Saint Louis University (US)
- Department of Surgery, University of Washington Medical Center, Seattle
- Corresponding author
- Parent, Brodie
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2018-05-01
- Volume
- 153
- Issue
- 5
- Pages
- 464
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC5875375
- OpenAlex
- W2781996768
- Cited by
- 46
- References
- 15
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 12 · 2020: 3 · 2019: 7 · 2018: 5
- FWCI
- 8.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- handoff communication, patient handover, intensive care unit, clinician preparedness, patient safety, mechanical ventilation duration, ICU length of stay, reintubation, surgical residents, communication errors, stepped wedge design
- MeSH terms
- Communication, Curriculum, Humans, Intensive Care Units, Internship and Residency, Practice Patterns, Physicians', Surveys and Questionnaires, Medical Errors, Patient Safety, Patient Handoff
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