I‑PASS

I‑PASS
Name	I‑PASS
Type	Handoff mnemonic
Developer	Boston Children’s Hospital; Pediatric Research in Inpatient Settings Network
Introduced	2010s
Field	Patient safety, Quality improvement
Purpose	Standardize handoff communication in clinical care

I‑PASS I‑PASS is a standardized mnemonic and handoff protocol designed to reduce communication errors during clinical transitions of care. Originating from pediatric research networks and implemented across academic and community hospitals, it integrates structured elements intended to improve situational awareness and reduce adverse events during shift changes. The framework has been evaluated in multi-center trials and quality collaboratives involving pediatric, internal medicine, and surgical services.

Overview

I‑PASS was developed through collaborations among teams at Boston Children’s Hospital, Harvard Medical School, and the Pediatric Research in Inpatient Settings Network to address gaps identified in handoff studies from institutions such as Johns Hopkins Hospital, Brigham and Women’s Hospital, and Mayo Clinic. The mnemonic organizes handoffs into defined elements to create a shared mental model for clinicians from organizations including American Academy of Pediatrics, Society of Hospital Medicine, and Institute for Healthcare Improvement. Early advocates linked the approach to broader patient-safety movements associated with leaders like Lucian Leape and initiatives at Agency for Healthcare Research and Quality.

Structure and Components

The core mnemonic divides information into discrete components that clinicians deliver in verbal and written formats, aligning with documentation practices used at institutions such as Cleveland Clinic, Massachusetts General Hospital, and Stanford Health Care. Components mirror cognitive-support strategies championed by Atul Gawande and draw on checklists similar to those in World Health Organization surgical safety work. Typical elements correspond to problem identification, action plans, contingency planning, and synthesis by the receiver, paralleling frameworks used by National Quality Forum and The Joint Commission for handoff standardization.

Implementation and Training

Implementation efforts often use multifaceted campaigns combining didactic sessions, simulation exercises, and faculty coaching modeled on programs from University of Pennsylvania Health System, University of California, San Francisco, and Yale New Haven Hospital. Training curricula incorporate simulation centers like those at Children’s Hospital of Philadelphia and assessment methods found in American Board of Internal Medicine training milestones. Quality-improvement methodology during rollouts frequently employs tools from Lean (methodology) and Six Sigma projects as applied in hospital systems such as Kaiser Permanente and Intermountain Healthcare.

Evidence of Effectiveness

A prominent cluster randomized trial led by investigators associated with Boston Children’s Hospital reported reductions in medical errors and preventable adverse events, echoing findings from earlier single-center studies at University of Pittsburgh Medical Center and Vanderbilt University Medical Center. Meta-analyses comparing standardized handoff protocols including I‑PASS with usual care cite improvements in communication reliability and situational awareness in pediatric and adult settings studied at institutions like Columbia University Irving Medical Center and Duke University Hospital. Outcomes tracked by measurement frameworks from Centers for Medicare & Medicaid Services and National Institutes of Health included error rates, adverse events, and provider satisfaction across participating hospitals.

Variations and Adaptations

Adaptations of the protocol have been reported for specialties and contexts including Emergency Department handoffs at centers such as Massachusetts General Hospital and Beth Israel Deaconess Medical Center, perioperative transitions at Johns Hopkins Hospital and Cleveland Clinic, and nursing shift reports in systems like Providence Health & Services. International adaptations have been implemented in tertiary centers in United Kingdom, Australia, and Canada, integrating local patient-safety policies from bodies such as National Health Service and Australian Commission on Safety and Quality in Health Care. Electronic health record integrations have been piloted with vendors used by Epic Systems Corporation and Cerner Corporation to auto-populate I‑PASS fields.

Criticism and Limitations

Critiques from clinicians and scholars associated with Oxford University Hospitals and policy analysts at RAND Corporation highlight challenges including scalability in low-resource settings, workflow disruption noted in studies from Montefiore Medical Center, and variability in adherence across departments such as Surgery and Intensive Care Units at institutions like Mount Sinai Health System. Concerns raised by implementation scientists at University of Michigan emphasize potential overreliance on templates that may obscure clinical nuance, and legal scholars at Harvard Law School caution about documentation practices in medicolegal contexts. Ongoing research from consortia including Society of Critical Care Medicine seeks to refine measurement of long-term outcome impacts and contextual moderators documented in comparative studies.

Category:Patient safety