Amaram-Davila Jaya, Vega Maria Franco, Bramati Patricia, Stewart Holly, Aceves Monica, Dalal Shalini, Reddy Akhila, Azhar Ahsan, Reddy Suresh K, Bodurka Diane C, George Marina, Aiss Mohamed Ait, Bruera Eduardo
Department of Palliative, Rehabilitation, and Integrative Medicine The University of Texas MD Anderson Cancer, Houston, TX 77030, USA.
Department of Hospital Medicine, The University of Texas MD Anderson Cancer, Houston, TX 77030, USA.
Cancers (Basel). 2025 Sep 1;17(17):2875. doi: 10.3390/cancers17172875.
Inpatient palliative care consultation services operate with an interdisciplinary team, where effective handoffs are crucial for coordinated patient care. We aimed to replace encrypted email handoffs with a more concise and uniform handoff using I-PASS (illness severity, patient summary, action list, situational awareness, contingency planning, and synthesis by receiver) integrated within the electronic medical record (EMR). Aim and Measures: Within six months of launch, our goal was to achieve 90% I-PASS utilization for hospitalized acutely ill patients with cancer receiving palliative care consultation.
In January 2021, our quality improvement team, consisting of physicians, advanced practice providers, and trainees, began implementing I-PASS using the plan-do-study-act cycle. After providing training sessions for all palliative care clinicians, I-PASS went live on October 1, 2021. I-PASS utilization was tracked via random and monthly audits of EMRs. Through anonymous surveys, both pre- and post-implementation, we gathered clinician feedback and concerns about the handoff system. Survey responses were compared using the Mann-Whitney test.
Within six months of implementation, the I-PASS utilization rate reached > 99%. The survey participation rates were 70% (45/64) and 82% (49/60) for the pre-and post-implementation periods, respectively. Respondents provided answers on one to five scale (mean, standard deviation, SD): lower accuracy with email (3.53, SD = 0.98) vs. I-PASS (4.20, SD = 0.83), < 0.001; handoff lengthier with email (4.17, SD = 1.05) vs. I-PASS (2.1, SD = 1.15), < 0.001; the time required was longer with email (3.0, SD = 1.22) vs. I-PASS (1.71, SD = 0.73), < 0.001. Overall, respondents found I-PASS to be significantly better (4.69, SD = 0.58).
I-PASS was fully adopted by the team, with nearly 100% utilization and strong clinician endorsement as an effective communication tool. Future efforts should focus on optimizing usability, particularly by educating clinicians on smartphone EMR access and enabling the timely and streamlined editing of I-PASS.
住院姑息治疗咨询服务由多学科团队开展，有效的交接对于协调患者护理至关重要。我们旨在用电子病历（EMR）中集成的I-PASS（疾病严重程度、患者摘要、行动清单、态势感知、应急计划以及接收方综合）取代加密电子邮件交接，以实现更简洁统一的交接。目标与措施：在推出后的六个月内，我们的目标是使接受姑息治疗咨询的急性病住院癌症患者的I-PASS使用率达到90%。
2021年1月，我们由医生、高级执业人员和实习生组成的质量改进团队开始使用计划-执行-研究-行动循环实施I-PASS。在为所有姑息治疗临床医生提供培训课程后，I-PASS于2021年10月1日上线。通过对电子病历的随机和月度审核来跟踪I-PASS的使用率。通过匿名调查，在实施前后收集临床医生对交接系统的反馈和担忧。使用曼-惠特尼检验比较调查回复。
在实施后的六个月内，I-PASS使用率达到>99%。实施前和实施后的调查参与率分别为70%（45/64）和82%（49/60）。受访者按1至5分制回答（均值、标准差，SD）：电子邮件的准确性较低（3.53，SD = 0.98），而I-PASS为（4.20，SD = 0.83），<0.001；电子邮件的交接时间更长（4.17，SD = 1.05），而I-PASS为（2.1，SD = 1.15），<0.001；电子邮件所需时间更长（3.0，SD = 1.22），而I-PASS为（1.71，SD = 0.73），<0.001。总体而言，受访者认为I-PASS明显更好（4.69，SD = 0.58）。
该团队完全采用了I-PASS，使用率近100%，临床医生强烈认可其为有效的沟通工具。未来的工作应侧重于优化可用性，特别是通过培训临床医生如何通过智能手机访问电子病历以及实现对I-PASS的及时、简化编辑。
