From the Harvard Combined Orthopaedic Residency Program, Boston, MA (Dr. Stenquist, Dr. Yeung); the Harvard Medical School, Boston, MA (Szapary); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Rossi, Dr. Harris); and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Chen).
J Am Acad Orthop Surg Glob Res Rev. 2022 Sep 6;6(9). doi: 10.5435/JAAOSGlobal-D-22-00079. eCollection 2022 Sep 1.
The I-PASS tool has been shown to decrease medical errors in patient handoffs in nonorthopaedic surgery fields. We prospectively studied the implementation of a version of this handoff tool modified for orthopaedic surgery patients in an academic practice at two level I trauma centers.
This was a prospective study of a multicenter handoff improvement program. Handoffs were evaluated preintervention and at 1, 6, 9, and 18 months postintervention for key data elements defined by I-PASS. Rates of adverse clinical outcomes were compared before and after the handoff intervention.
Seven hundred five electronic patient handoffs were analyzed. From preintervention to the 18-month time point, notable improvement was observed in 8 of 9 targeted quality elements. In Poisson regression analysis, adherence to the standardized handoff format was sustained at markedly improved levels throughout all postintervention time points. No statistically significant differences were observed between rates of 30-day readmission, 90-day readmission, urinary tract infection, pulmonary embolism/deep vein thrombosis, surgical site infection, or delirium before and after the intervention.
Introduction of an orthopaedic-specific I-PASS tool produced sustained adherence from a group of over 50 orthopaedic providers. Objective quality of handoffs improved markedly as defined by the I-PASS standard, and 86% of the providers supported the ongoing use of the tool. Despite the improvement in handoff quality, we were unable to demonstrate a notable change in measured clinical outcomes. Methods for the development and implementation of the orthopaedic-specific I-PASS tool are described. Orthopaedic residency programs should consider using a version of I-PASS to standardize care.
I-PASS 工具已被证明可减少非骨科手术领域的患者交接中的医疗错误。我们前瞻性地研究了在两个 I 级创伤中心的学术实践中，为骨科患者修改的该交接工具的版本的实施情况。
这是一项多中心交接改进计划的前瞻性研究。交接在干预前和干预后 1、6、9 和 18 个月进行评估，评估内容为 I-PASS 定义的关键数据要素。比较交接干预前后不良临床结局的发生率。
分析了 705 份电子患者交接记录。从干预前到 18 个月的时间点，在 9 个目标质量要素中的 8 个方面观察到显著改善。在泊松回归分析中，在所有后续的干预时间点，标准化交接格式的遵守率都保持在明显改善的水平。干预前后，30 天再入院率、90 天再入院率、尿路感染、肺栓塞/深静脉血栓形成、手术部位感染或谵妄的发生率没有统计学差异。
引入特定于骨科的 I-PASS 工具后，超过 50 名骨科医生的持续遵守率很高。交接质量的客观质量明显改善，符合 I-PASS 标准，86%的医生支持该工具的持续使用。尽管交接质量有所提高，但我们未能证明测量的临床结局有明显变化。描述了开发和实施特定于骨科的 I-PASS 工具的方法。骨科住院医师培训项目应考虑使用 I-PASS 来规范护理。
