How to Improve Clinical Care Transitions by Boosting Communication

Miscommunication in the hospital setting is a major driver of medical errors and malpractice claims.

Appalachian Regional Healthcare (ARH), which operates 14 hospitals in Kentucky and West Virginia, is adopting a structured communications program for clinical care transitions that has been shown to reduce medical errors.

Miscommunication during clinical care transitions is a major factor in medical errors and malpractice claims. A study published in the Journal of Patient Safety showed that during a 10-year period nearly half of all medical malpractice claims involved communication failures, 77% of which could have been prevented with an effective patient handoff tool.

With financial support from the Kentucky Hospital Association, ARH is implementing I-PASS, a communications bundle for clinical care transitions developed by the I-PASS Patient Safety Institute. I-PASS has been adopted by more than 100 healthcare institutions.

I-PASS is a bundle of interventions to try to improve patient handoffs and communication in hospitals.

"The primary element is to get caregivers to speak with each other in a consistent way about patients as they are passing off patients at the change of a shift or a change of location," says Christopher Landrigan, MD, MPH, co-founder and executive council member at the I-PASS Patient Safety Institute.

• The I in I-PASS stands for illness severity, so caregivers have a solid understanding of a patient's medical status.
   
• The P in I-PASS stands for the patient summary, which summarizes the condition of the patient, why they are in the hospital, and what care has been provided since the patient was admitted to the hospital.
   
• The A in I-PASS stands for action list, which is a list of things that are expected to happen in a patient's care.
   
• The first S in I-PASS is situational awareness, which includes telling caregivers what is special about a patient.
   
• The final S in I-PASS is synthesis by receiver, which is designed to make sure that when there is a handoff of a patient that the caregivers are on the same page.

I-PASS includes infrastructure that supports improved communication, Landrigan says.

"We think a lot about how we train people, how we implement I-PASS in a way that is going to stick, how we build tools into the electronic health record, and how we use devices in a hospital to push the program forward," he says. "We want to pass along patient information in a reliable manner every day."

Research has shown that I-PASS significantly reduces medical errors and adverse patient events.

A study on I-PASS published by the New England Journal of Medicine found a 23% reduction in medical-error rate and 30% reduction in the rate of preventable adverse events after the implementation of I-PASS. The researchers reviewed 10,740 patient admissions (5,516 preintervention and 5,224 postintervention).

I-PASS is a better framework for communication, says Anthony Stumbo, MD, regional chief medical officer at ARH.

"If a patient comes in with pneumonia, you may think they are going to get better, but you may get a call in the middle of the night that the patient cannot breathe and must be placed on a ventilator," he says. "Communication is key. I-PASS standardizes communication."

Stumbo expects ARH will generate several benefits for the health systems and its patients once I-PASS is implemented at the 12 ARH hospitals in Kentucky. "I expect better communication. I expect better clinical outcomes. I expect better quality. I expect less medical errors. I expect decreased malpractice claims. I expect better care transitions. The handoff of a patient from one nurse to another or one clinician to another is critical—there must be a flow of information," he says.

Investment and ROI

The implementation of I-PASS is going to require limited investment by ARH, Landrigan says.

"The good news for ARH is that the Kentucky Hospital Association has committed to the adoption of I-PASS at ARH," he says. "The hospital association has put up most of the funding to make this program happen. Certainly, the leaders and care teams at ARH are going to have to invest time and energy."

The return on investment from I-PASS includes lower malpractice claims and efficiency gains, which can generate a 3-to-1 ROI, Landrigan says.

"We have found that nursing overtime and the amount of time it takes nurses to do a patient handoff has decreased significantly," he says. "That has benefits in overtime costs and the quality of life for nurses, who can get out of the hospital when they are scheduled to get out of the hospital. With the nursing shortage across the country, anything we can do to improve the work-life balance of nurses is beneficial."