A Quality Improvement Project: Development and Implementation of a Modified I-PASS Handover in the General Surgery Department of Tertiary Care Hospital in Pakistan

Abstract

Introduction: In tertiary care settings, multidisciplinary teams are responsible for providing hi-tech, state of the art health care to the patients, which is impossible without a transparent, accountable communication system within and between teams, i.e. the patient handover.

Aims & Objectives: This project aimed to introduce a handover document, based on handover best practices, in the General Surgery Department of Shaikh Zayed Hospital, Lahore, and improve it over time to make it compatible with the unique local demands.

Place and duration of study: From 01 October 2019 to 30 March 2020 in General Surgery Department of Shaikh Zayed complex, Lahore, Pakistan.

Material & Methods: The need for an official and standard handover for the general surgery department was discussed with a few stakeholders. Upon a thorough search of the literature, a slightly modified version of the I-PASS handover system was introduced. It contained items such as Biodata, diagnosis, active complaint, management, tasks to be done, potential risks, verbal handover and severity of the disease. Before the introduction of handover documents, a training session was held with three residents. Six months after the handover was introduced, qualitative feedback was collected from trainee residents and consultants in the General Surgery department.

Results: Results showed compliance of 80% by residents (n=20), perceived improvement in patient safety standards and better organization of patient data by 95% of respondents (n=20). First Plan, Study, Design, Act cycle was completed. A second PSDA cycle was initiated. A new form of I-PASS handover system, based on feedback, was put in place in the General Surgery Department.

Conclusion: This undertaking has fulfilled one of the recommendations of the Joint Commission and WHO to improve patient safety, and it also demonstrates that a structured handover improves the transfer of information among residents, minimizes errors and help avoidance of negligence.