I-PASS Handoff Curriculum: Handoff Simulation Exercises

Abstract I-PASS role-plays are simulation exercises that serve to bring all the I-PASS curricular elements together. The role-plays allow practice with the techniques and include resident and faculty feedback to help learners refine the skills learned and place them in context. Three role-plays involve performing an I-PASS handoff with a giver, receiver, and observer. Communication challenges, such as interruptions, are introduced in later role-plays to increase complexity as learners go through the exercises. The observer uses the faculty observation tools that faculty will subsequently use to evaluate live handoffs. The final role-play focuses on developing a shared mental model. In this exercise, each group of three is divided into a giver and two receivers who develop the action items, as well as the situation awareness and contingency planning portions of the written handoff based on the information from the giver. Neighboring groups perform the same exercise with slightly different information and then compare their success in developing a shared mental model. In brief, we found in a detailed review of 10,740 patient admissions that a 23% reduction in medical errors and a 30% reduction in injuries due to medical errors (preventable adverse events) occurred following implementation of the I-PASS Handoff Bundle in nine academic medical centers. In direct observation of thousands of hours of resident workflow (time motion analysis) before and after implementation of the program, conducting handoffs using the I-PASS method was found to require no more time per handoff, and resident workflow throughout the shift was likewise unchanged, including no change in the amount of time spent at the computer or in direct patient care.