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Ipass states5/31/2023 ![]() Previous studies have shown that abnormal vital signs during hospitalization led to increased risk for clinical deterioration. 12 – 16 The advantage to using the I-PASS illness severity is the increasing adoption of this method for handoffs, so additional training and information at the time of handoff is not needed. Several early warning systems have been studied, including the Patient Acuity Rating, Modified Early Warning System, and others. Our results showed that illness severity within I-PASS handoffs could be an effective early warning system for clinical deterioration. 10 In-hospital mortality after overnight RRT in this study was 28.6%, near the upper range of 15% to 29% reported in the literature. Escalation of patient care occurred in 38.8% of RRTs, which mirrors findings of a larger nationwide study. 7 – 9 Our study showed no statistical differences for these analyses, which may be partly due to the inadequate power from the number of RRT activations meeting the inclusion criteria. Several studies have shown variations in clinical care and RRT activation based on month of the academic year, timing in the night, and weekends. Compared with patients categorized as stable, the likelihood for overnight clinical deterioration was 2.6 times higher for patients listed as watcher and 5.2 times higher for those listed as star. ![]() This study demonstrated that the illness severity category of I-PASS handoffs could identify patients at higher risk for overnight clinical deterioration. ![]() To evaluate the effectiveness of the I-PASS handoff bundle implementation, we evaluated the illness severity assigned to patients who had overnight clinical deterioration defined by rapid response team (RRT) activation. Despite increasing adoption of structured handoff systems by training programs, to our knowledge there are no studies using the components of the handoff to assess risk of clinical decompensation. The I-PASS study designated the illness severity categories as stable, watcher, and unstable, with watcher defined as “any clinician's ‘gut feeling' that a patient is at risk of deterioration or ‘close to the edge.'” 3, 4Įffective communication during patient handoffs should prioritize patients who are at a higher risk for deterioration and enable the cross-covering resident to anticipate and efficiently address potential causes of clinical deterioration. 5 The illness severity component requires residents to assign patients to 1 of 3 categories based on their clinical assessment of the likelihood of deterioration. I-PASS is a mnemonic for the key elements of the handoff process: I, illness severity P, patient summary A, action items S, situation awareness and contingency planning and S, synthesis by receiver. 2 A recent multicenter study demonstrated that implementing a standardized handoff bundle, referred to as I-PASS, decreased medical errors and preventable adverse events. 1 This is particularly important during patient handoffs, which have increased in frequency after restrictions on resident work hours. ![]() Chirayu Shah, MD, MEd, is Associate Professor, Department of Medicine, Baylor College of Medicine, and Clinical Faculty, Harris Health System Khaled Sanber, MD, is Internal Medicine Resident, Department of Medicine, Baylor College of Medicine Rachael Jacobson, MD, is Internal Medicine Resident, Department of Medicine, Baylor College of Medicine Bhavika Kaul, MD, is Chief Internal Medicine Resident, Department of Medicine, Baylor College of Medicine, and Chief Resident, Harris Health System Sarah Tuthill, MD, is Internal Medicine Resident, Department of Medicine, Baylor College of Medicine Vagish Hemmige, MD, is Associate Professor, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center Elizabeth Guy, MD, is Assistant Professor, Department of Medicine, Baylor College of Medicine, and Clinical Faculty, Harris Health System and Stephen Greenberg, MD, is Distinguished Service Professor, Departments of Medicine, Microbiology, and Immunology, Baylor College of Medicine, and Chief of Medicine Service and Vice Chief of Staff for Academic and Educational Affairs, Harris Health System.Ĭommunication failure has been increasingly recognized as a major cause of preventable adverse events in hospitalized patients. ![]()
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