What is the IPASS (Illness severity, Patient summary, Action list, Situational awareness and contingency plans, and Synthesis by receiver) handoff structure?

The IPASS Handoff Structure

The IPASS handoff structure is a standardized communication tool that improves patient safety by reducing medical errors and preventable harm during transitions of care through a structured format consisting of Illness severity, Patient summary, Action list, Situational awareness and contingency plans, and Synthesis by receiver.

Components of IPASS

The IPASS mnemonic represents five key elements that should be included in every patient handoff:

1. Illness Severity: An assessment of how sick the patient is, typically categorized as:

   • Stable
   • Watcher (potentially unstable)
   • Unstable

2. Patient Summary: A concise overview of the patient including:

   • Demographics
   • Diagnosis/chief complaint
   • Brief history of present illness
   • Current clinical status
   • Relevant medical history
   • Key test results

3. Action List: Clearly defined tasks that need to be completed, including:

   • To-do items with clear ownership
   • Timeline for completion
   • Pending tests and studies
   • Medication administration schedules

4. Situational Awareness and Contingency Plans: Anticipatory guidance including:

   • "If/then" statements for potential clinical changes
   • Specific parameters that should trigger concern
   • Recommended responses to potential deterioration
   • Resource availability considerations

5. Synthesis by Receiver: Active participation by the receiving clinician:

   • Summarizing what was heard
   • Asking questions for clarification
   • Restating key action items
   • Confirming understanding of contingency plans

Evidence Supporting IPASS Implementation

Research has demonstrated that IPASS implementation significantly improves communication and patient safety outcomes. A 2020 study showed that when properly implemented, IPASS was used in 87% of inpatient nursing handoffs, 76% of physician handoffs, and 89% of imaging/procedures handoffs 1.

Implementation of IPASS in a community pediatric residency program showed specific improvements in:

• Situational awareness with contingency planning (increased from 12% to 83% in nursery settings and 21% to 84% in floor settings)
• Reduction in tangential conversations during handoffs
• Improved identification of illness severity
• Fewer omissions of important information 2

Implementation Strategies

Successful implementation of IPASS requires:

1. Institutional Support: Gaining buy-in from leadership and frontline providers

2. Customized Documentation Tools: Adapting written or electronic handoff documents to incorporate the IPASS structure

   • Electronic physician handoff (EPH) systems have shown particular benefit in improving handoff quality 2

3. Education and Training:

   • Flipped classroom approach
   • TeamSTEPPS team communication strategies
   • Verbal handoff simulation scenarios
   • Printed handoff document exercises 3

4. Peer Observation and Feedback: Regular monitoring of handoff quality with constructive feedback

5. Adaptation to Specific Settings: While originally validated for physician handoffs, IPASS has been successfully adapted for:

   • Inpatient nursing bedside report
   • Emergency department transitions of care
   • Pediatric critical care transport
   • Imaging and procedural handoffs 1, 4, 5

Benefits of IPASS Implementation

When properly implemented, IPASS provides several key benefits:

• Reduced Medical Errors: Standardized handoffs decrease communication failures that contribute to adverse events
• Improved Information Transfer: Less perceived loss of important patient information (reduced by 50% in one study) 4
• Enhanced Team Communication: Clearer expectations and responsibilities
• Increased Provider Satisfaction: 93% of residents in one study found electronic IPASS systems beneficial 2
• Smoother Patient Transfers: Physical transfers of patients go more smoothly with standardized handoffs 5

Common Pitfalls and How to Avoid Them

1. Incomplete Adoption: Ensure all team members are trained and held accountable for using all five elements of IPASS

2. Perception of Increased Handoff Time: While some providers initially report longer handoffs (50% in one study), the improved quality and reduced errors justify this investment 4

3. Lack of Customization: Adapt IPASS to specific clinical contexts while maintaining the core elements

4. Inadequate Receiver Participation: Emphasize the importance of active synthesis by receivers, not just passive listening

5. Failure to Maintain Implementation: Use regular peer observations and feedback to sustain usage over time

IPASS represents a significant advancement in standardizing handoff communication across healthcare settings, with demonstrated improvements in patient safety outcomes when properly implemented and maintained.