I-CATCH: A Novel Bundle to Improve Postcall Morning Handoffs

Background Conducting postcall morning handoffs using a resident handoff bundle such as I-PASS can prove challenging. This may delay recognizing and acting on clinically important patient issues that arose overnight. Objective We developed and implemented the I-CATCH morning handoff bundle and evaluated its impact on the proportion of overnight patient issues handed off from the on-call resident to the daytime team. Methods We evaluated the I-CATCH (Identify patient; Characterize situation; Action–what was done overnight?; To do for the team in the morning; Confirm the Handoff) handoff bundle from November 2015 to May 2016 on general internal medicine wards at 1 academic teaching hospital. The bundle entailed staff/resident training, structured communication, and dedicated handoff space and time. We compared handoffs of overnight on-call issues by evening resident to daytime medical team before and after implementation, and used statistical process control to analyze adherence to the mnemonic. Results We observed 435 handoffs (242 pre- and 193 postimplementation) over 63 days. There was no significant association between I-CATCH implementation and proportion of on-call overnight issues handed off (OR = 0.96; 95% confidence interval [CI] 0.52–1.47; P = .85). Running the list by going through patients one-by-one (OR = 1.74; 95% CI 1.1–2.77; P = .019), progress note documentation (OR = 3.80; 95% CI 2.19–6.60; P < .001), and direct handoff (OR = 4.84; 95% CI 1.43–16.42; P = .011) correlated with an increased likelihood of morning handoff. Conclusions Implementing the I-CATCH bundle did not improve handoff of overnight issues to the daytime team.