Faculty of Medicine, University of Geneva, Geneva, Switzerland.
University Hospitals of Geneva, Geneva, Switzerland.
BMC Med Educ. 2024 Sep 27;24(1):1046. doi: 10.1186/s12909-024-05880-7.
Miscommunications account for up to 80% of preventable medical errors. Mnemonics like I-PASS (Illness severity, Patient summary, Actions list, Situation awareness, Synthesis) have demonstrated a positive impact on reducing error rates. Currently, physicians at our hospital do not follow a specific structure during hand-offs. We aimed to compare current hand-offs without prior training to a gold standard and the I-PASS tool in terms of content and sequence.
This study is a secondary analysis of data collected during a simulation study of a Friday evening hand-off to the night resident at University Hospitals of Geneva. Thirty physicians received a hand-off of four patients and managed two other patients through nursing pages at the start of the night shift, generating six sign-outs each, totaling 177 sign-outs. A focus group of three senior doctors defined the gold standard (GS) by consensus on the essential content of each sign-out. The analysis focused on the rates of relevance (ratio of information considered relevant by the GS) and completeness (proportion of transmitted elements out of all expected elements of the GS), and the distribution and sequence of the first four I-PASS categories.
Relevance and completeness rates were 37.2% ± 0.07 and 51.9% ± 0.1, respectively, with no significant difference between residents and supervisors. There was a positive correlation between total hand-off time and relevance (residents: R = 0.62; supervisors: R = 0.67) and completeness (residents: R = 0.32; supervisors: R = 0.56). The distribution of I-PASS categories was highly skewed in both the GS (I = 2%, P = 72%, A = 17%, S = 9%) and participants (I = 6%, P = 73%, A = 14%, S = 7%), with significant differences in categories A (p = 0.046) and I (p ≤ 0.001). Sequences of I-PASS categories generally followed a P-A-S-I pattern. The first S category was frequently absent, and only one participant began by announcing the case severity as suggested by I-PASS.
We identified gaps between current medical sign-outs in our institution's general internal medicine division and the I-PASS structure. We recommend implementing the I-PASS mnemonic, emphasizing the "I" category at the start and the "S" category to anticipate and prevent complications. Future studies should assess the impact of this recommendation, adapt the mnemonic elements to the context, and introduce specific hand-off training for senior medical students.
沟通失误占可预防医疗错误的 80%。助记符，如 I-PASS（病情严重程度、患者总结、行动清单、情境意识、综合），已证明对降低错误率有积极影响。目前，我们医院的医生在交接班时没有遵循特定的结构。我们旨在比较当前未经培训的交接班与黄金标准和 I-PASS 工具在内容和顺序方面的差异。
这是一项对日内瓦大学医院周五晚上夜间住院医师交接班模拟研究中收集的数据进行的二次分析。30 名医生接收了 4 名患者的交接班，并在夜班开始时通过护理页面管理了另外 2 名患者，每人生成了 6 次交接班，总共生成了 177 次交接班。一个由三名资深医生组成的焦点小组通过共识确定了黄金标准 (GS)，即每个交接班中必要内容的共识。分析重点是相关性（GS 认为相关的信息比例）和完整性（传输的元素与 GS 中所有预期元素的比例），以及前四个 I-PASS 类别的分布和顺序。
相关性和完整性的比率分别为 37.2%±0.07 和 51.9%±0.1，住院医师和主管医生之间没有显著差异。总交接班时间与相关性（住院医师：R=0.62；主管医生：R=0.67）和完整性（住院医师：R=0.32；主管医生：R=0.56）呈正相关。在 GS（I=2%，P=72%，A=17%，S=9%）和参与者（I=6%，P=73%，A=14%，S=7%）中，I-PASS 类别分布高度偏斜，A 类别的分布存在显著差异（p=0.046）和 I 类（p≤0.001）。I-PASS 类别的顺序通常遵循 P-A-S-I 模式。第一个 S 类别经常缺失，只有一名参与者按照 I-PASS 的建议宣布病例严重程度。
我们发现我们医院普通内科部门当前的医疗交接班与 I-PASS 结构之间存在差距。我们建议实施 I-PASS 助记符，强调在开始时使用“ I”类别，并使用“S”类别来预测和预防并发症。未来的研究应该评估这一建议的影响，使助记符元素适应具体情况，并为高级医学生引入特定的交接班培训。
