Introduction of the EMR-integrated I-PASS ICU Handoff Tool

It was with enthusiasm that we read the article, Addition of CORES to the I-PASS Handoff: A Resident-led Quality Improvement Study.¹ Tufts et al¹ describe the improvement of the resident-to-resident handoffs utilizing CORES, which is an electronic tool that generates handoff lists with prepopulated patient data, organized in the I-PASS format.¹ The I-PASS handoff mnemonic stands for Illness severity, Patient summary, Action list, Situation planning, and Synthesis.² CORES is created by TransformativeMed (Seattle, Wash.). The authors describe its integration with their institution’s electronic medical record (EMR), Cerner (North Kansas City, Mo.).¹ The authors should be applauded for their efforts, as transitions of care have been associated with increased morbidity.

Although integration of the third-party applications into EMRs offer advantages, including technical support, utilization of these applications can also expose EMRs to cyber threats and include additional costs. At our pediatric, academic hospital, the I-PASS mnemonic is also used as the standard handoff delivery method throughout the hospital, including OR to pediatric intensive care unit (PICU) handoffs. Medication errors during OR to PICU transitions are particularly problematic given differences in charting between the two locations, as anesthesiologists typically chart in an intraoperative one-step medication activity that combines order and administration detail. Nurses chart in the medication administration record.³ We introduce an internally developed I-PASS handoff tool that leverages both the in-person, verbal principles of I-PASS with discretely documented elements stored in our EMR, EPIC (Verona, Win.).

Providers were able to locate the majority of the proposed data for the I-PASS tool in the EMR. Still, the data were scattered in different areas of encounter types (surgical log, anesthesia record, procedure notes, orders, and medication administration record). Given the inefficient process for the receiving PICU team to extract these data before patient arrival and the potential for recall and scribing errors by the delivering OR team, we proposed automatic, electronic data capture. Using an organ system approach, we translated pertinent procedural, medication, and fluid information into technical specifications for an analytics programmer to code. Once the Clinical Informaticist located the discreet data fields, the programmer wrote a code to extract and manipulate the data into a concise and precisely ordered, print-enabled I-PASS layout, with minimal free-text documentation.

After the development of this tool, the anesthetic and surgical procedural details reliably populated into the I-PASS tool. During utilization, providers noted facility with determining: (1) key medication details, including the dose and timing of last antibiotic; (2) indwelling line details; (3) intubations details, including the type of laryngoscope, view, and size of the tracheal tube; and (4) fluid and blood resuscitation.

We present a novel, institutionally developed, EMR-integrated OR to PICU handoff tool. This tool may be an alternative solution for hospitals that choose not to utilize external applications. By leveraging the I-PASS process and an EMR-generated report, we not only can facilitate the reliable transfer of information but also use the report as a template for the OR team to follow during handoff and as a learning tool for the PICU team.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.