Importance Clinician miscommunication contributes to an estimated 250 000 deaths in US hospitals per year. Efforts to standardize handoff communication may reduce errors and improve patient safety.

Objective To determine the effect of a standardized handoff curriculum, UW-IPASS, on interclinician communication and patient outcomes.

Design, Setting, and Participants This cluster randomized stepped-wedge randomized clinical trial was conducted from October 2015 to May 2016 at 8 medical and surgical intensive care units at 2 hospital systems within an academic tertiary referral center. Participants included residents, fellows, advance-practice clinicians, and attending physicians (n = 106 clinicians, with 1488 handoff events over 8 months) and data were collected from daily text message–based surveys and patient medical records.

Exposures The UW-IPASS standardized handoff curriculum

Main Outcomes and Measures The primary aim was to assess the effect of the UW-IPASS handoff curriculum on perceived adequacy of interclinician communication. Patient days of mechanical ventilation, intensive care unit length of stay, reintubations within 24 hours, and order workflow patterns were also analyzed. Mixed-effects logistic regression was used to compute odds ratios and confidence intervals with adjustment for location, time period, and clinician.

Results A total of 63 residents and advance practice clinicians, 13 fellows, and 30 attending physicians participated in the study. During the control period, clinicians reported being unprepared for their shift because of a poor-quality handoff in 35 of 343 handoffs (10.2%), while UW-IPASS–period residents reported being unprepared in 53 of 740 handoffs (7.2%) (odds ratio, 0.19; 95% CI, 0.03-0.74; P = .03). Compared with the control phase, the perceived duration of handoffs among clinicians using UW-IPASS was unchanged (+5.5 minutes; 95% CI, 0.34-9.39; P = .30). Early morning order entry decreased from 106 per 100 patient-days in the control phase to 78 per 100 patient-days in the intervention period (−28 orders; 95% CI, −55 to −4; P = .04). Overall, UW-IPASS was not associated with any changes in intensive care unit length of stay, duration of mechanical ventilation, or the number of reintubations.

Conclusions and Relevance The UW-IPASS standardized handoff curriculum was perceived to improve intensive care provider preparedness and workflow. IPASS-based curricula represent an important step forward in communication standardization efforts and may help reduce communication errors and omissions.

Trial Registration isrctn.org Identifier: ISRCTN14209509

重要性 临床医生沟通不畅导致美国医院每年估计有25万人死亡。标准化切换通信的努力可以减少错误并提高患者安全性。

目的 确定标准的交接课程UW-IPASS对临床医生之间的交流和患者预后的影响。

设计，设置和参加者 该研究于2015年10月至2016年5月在学术三级转诊中心的2个医院系统的8个医疗和外科重症监护病房进行了这项随机分组的阶梯式随机临床试验。参加者包括居民，研究员，先进的临床医生和主治医生（n = 106名临床医生，在8个月内发生1488例移交事件），并从基于文本消息的日常调查和患者病历中收集了数据。

暴露 UW-IPASS标准化交接课程

主要成果和措施 主要目的是评估UW-IPASS交接课程对临床医生之间交流的适当性的影响。还分析了患者的机械通气天数，重症监护病房的住院时间，24小时内重新插管以及订购工作流程的方式。使用混合效果逻辑回归来计算比值比和置信区间，并调整位置，时间段和临床医生。

结果 共有63名住院医师和高级临床医生，13名研究员和30名主治医师参加了研究。在控制期间，临床医生报告说，由于343次交接中的35次交接质量差（10.2％），他们不准备为自己的班次做准备；而UW-IPASS时期的居民报告，在740次交接中的53次交接中没有做好准备（7.2％）（奇数）比值：0.19； 95％CI，0.03-0.74；P  = .03）。与控制阶段相比，使用UW-IPASS的临床医生之间的切换持续时间没有变化（+5.5分钟； 95％CI，0.34-9.39；P  = .30）。清晨接单从控制阶段的每100个病人日的106个减少到干预期的每100个病人日的78个（-28个订单； 95％CI，-55至-4；P = .04）。总体而言，UW-IPASS与重症监护病房的住院时间，机械通气时间或再插管次数没有任何变化。

结论和相关性 UW-IPASS标准化交接课程被认为可以改善重症监护提供者的准备和工作流程。基于IPASS的课程代表了通信标准化工作的重要一步，可以帮助减少通信错误和遗漏。

试用注册 isrctn.org标识符：ISRCTN14209509