Evidence map›Paper›PMID 40992774›Full record

ArticleBMJ open quality2025

Using I-PASS to improve nursing handoffs across the continuum of care at a tertiary oncology hospital.

Mohamed Ait Aiss, Delmy Vesho, Christi Bowe, Maria C Franco Vega, Son Chau, Jeff Beno, Marina George, Carol Porter, Diane Bodurka

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open quality, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mohamed Ait AissEducation & Training Division, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA mait@mdanderson.org.ORCID 0009-0005-8045-2756
Delmy VeshoNursing Administration, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Christi BoweNursing Administration, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Maria C Franco VegaHospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID 0000-0001-6890-6130
Son ChauClinical & Access Applications, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jeff BenoOffice of Performance Improvement, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Marina GeorgeHospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Carol PorterNursing Administration, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Diane BodurkaEducation & Training Division, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCommunication failures can cause medical errors that harm patients. Handoffs occur frequently every day-every time a patient is transferred from one nurse to another (eg, shift change, hospital location). At our comprehensive cancer centre, handoffs became a priority focus area in our institution. PURPOSE: We implemented the evidence-based handoff tool I-PASS (Illness Severity, Patient Summary, Action List, Situation Awareness and Contingency Planning, and Synthesis by Receiver) for all nurses at our comprehensive cancer centre and assessed the uptake of the new framework and subsequent compliance and safety outcomes.

methodsOur team comprised representatives from nursing education, operations and informatics; a healthcare systems engineer; and electronic health record (EHR) analysts. Based on our observations of handoffs in different settings and feedback from focus group sessions, we developed an I-PASS handoff workflow in our EHR with the engagement of frontline staff and unit leaders. Various education modalities were implemented, and compliance was monitored through an EHR dashboard. Handoff audits were conducted for over a year after I-PASS was implemented to observe compliance with I-PASS reports for verbal handoffs. The institution's regularly administered safety culture survey results were assessed in the category of handoffs and information exchange.

resultsOur process measures, all nurses were trained to use I-PASS by 28 November 2022. Compliance in documenting I-PASS handoffs varied between 86% and 88% of all handoffs between December 2022 and April 2024. I-PASS elements were present in above 95% of verbal handoffs between April 2023 and April 2024. The percentage of clinical nurses who reported favourable handoffs in our institutional safety culture survey improved from 64% in 2022 to 72% in 2024. For our outcome measure, a rate of zero high-harm events was maintained during the same period.

conclusionThe dissemination method led to the full implementation of I-PASS across all nursing areas and improved handoff quality.

Indexed as

Continuity of Patient CarePatient HandoffFocus GroupsHumansQuality ImprovementSurveys and QuestionnairesTertiary Care CentersEducationPatient safetyQuality improvement

Identifiers

PMID40992774
PMCPMC12458891

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.