153: Resident Attitudes and Adherence to I-PASS: A Qualitative Study. Issue 6 (1st June 2014)

• Record Type: Journal Article
• Authors: Coffey, M; Thomson, K; Starmer, AJ; Landrigan, CP
• Is Part Of: Paediatrics & Child Health. Volume 19:Issue 6(2014)
• Page Start: e88
• Page End: e89
• Publication Date: 2014-06-01
• Subjects: Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/19.6.e35-150
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: BACKGROUND: The main I-PASS Study assesses the effectiveness of a Handoff Bundle (team training, verbal mnemonic, and electronic written handoff tool) at nine residency programs using quantitative data on patient safety outcomes as well as efficiency and provider satisfaction. OBJECTIVES: The objective of this ancillary qualitative study was to describe in detail the resident experience of I-PASS implementation, in general and with respect to the individual components, in order to inform future refinements and implementation strategies. DESIGN/METHODS: Focus groups with residents (n=54); and semi-structured interviews with faculty (n=28) and other personnel (n=10) were conducted at eight of nine I-PASS sites. A structured codebook was developed to facilitate descriptive coding of transcripts, and data were synthesized and summarized using content analysis. Triangulation was employed by comparing findings across data sources. RESULTS: Residents generally accept I-PASS to be a 'gold standard' form of handoff and value learning a structured approach. Junior residents and some senior residents feel more secure using a structured format and most recognize that the program enhances handoff quality and patient safety. Efficiency was the most common factor cited when residents expressed concern about I-PASS. They regard it as neither necessary nor feasible to follow I-PASS for every patient and situation. Across all sites, residents report adhering to I-PASS when observed, but adhering selectively in usual practice. Residents were more likely to adhere with complex patients, unfamiliar teams, and evening vs. morning handoff. They also report using elements of the I-PASS mnemonic variably, with "synthesis by receiver" rarely used outside the context of observation. Anything perceived to lengthen handoff was unwelcome. Most residents value the computerized written handoff tool, but at sites with significant tool usability problems, dissatisfaction extended to the whole I-PASS program. The degree to which resident feedback was sought and acted upon moderated this. Perceptions of the faculty role varied. Residents generally understood that faculty have different handoff needs and practices, so did not perceive faculty as hypocritical if they did not adhere to I-PASS themselves. The experiences of observation and feedback were mixed. Residents reported variation in faculty feedback styles; some residents found it constructive while others found it 'nitpicky'. CONCLUSIONS: Residents felt that the I-PASS program improved safety, but had concerns about efficiency. Optimizing computerized handoff tools, efficiency of verbal handoffs, and feedback to residents will be important in future refinements and implementation efforts.