PMID- 33893213 OWN - NLM STAT- MEDLINE DCOM- 20211027 LR - 20220531 IS - 2044-5423 (Electronic) IS - 2044-5415 (Linking) VI - 30 IP - 10 DP - 2021 Oct TI - Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial. PG - 782-791 LID - 10.1136/bmjqs-2020-012370 [doi] AB - BACKGROUND: There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes' effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs). METHODS: Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation. RESULTS: We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5-97.4) vs intervention 60.4 (33.2-109.9), p=0.99, risk ratio: 1.0 (0.74-1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6-41.8) vs intervention 34.7 min (26.5-42.1); difference 1.43 min (95% CI -2.63 to 5.49, p=0.49)). The providers' perception of improved communication did not change. CONCLUSIONS: After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs' frequency or the perception of enhanced communication. TRIAL REGISTRATION NUMBER: NCT03924570. CI - (c) Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Jorro-Baron, Facundo AU - Jorro-Baron F AUID- ORCID: 0000-0001-6887-9275 AD - Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina fjorro@iecs.org.ar. AD - PICU, Hospital General de Ninos Pedro de Elizalde, Buenos Aires, Argentina. FAU - Suarez-Anzorena, Ines AU - Suarez-Anzorena I AD - Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina. FAU - Burgos-Pratx, Rodrigo AU - Burgos-Pratx R AD - PICU, Hospital Materno Infantil 'Hector Quintana', San Salvador de Jujuy, Jujuy, Argentina. FAU - De Maio, Noelia AU - De Maio N AD - PICU, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina. FAU - Penazzi, Matias AU - Penazzi M AD - PICU, Hospital de Ninos de San Justo, San Justo, Provincia de Buenos Aires, Argentina. FAU - Rodriguez, Ana Paula AU - Rodriguez AP AD - PICU, Hospital General de Ninos Pedro de Elizalde, Buenos Aires, Argentina. FAU - Rodriguez, Gisela AU - Rodriguez G AD - PICU, El Hospital de Ninos Ricardo Gutierrez, Buenos Aires, Argentina. FAU - Velardez, Daniel AU - Velardez D AD - PICU, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina. FAU - Gibbons, Luz AU - Gibbons L AD - Statistics, Data Management and Information Systems, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina. FAU - Abalos, Silvina AU - Abalos S AD - PICU, Hospital Materno Infantil 'Hector Quintana', San Salvador de Jujuy, Jujuy, Argentina. FAU - Lardone, Silvina AU - Lardone S AD - PICU, Hospital de Ninos de San Justo, San Justo, Provincia de Buenos Aires, Argentina. FAU - Gallagher, Rosario AU - Gallagher R AD - PICU, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina. FAU - Olivieri, Joaquin AU - Olivieri J AD - PICU, El Hospital de Ninos Ricardo Gutierrez, Buenos Aires, Argentina. FAU - Rodriguez, Rocio AU - Rodriguez R AD - Statistics, Data Management and Information Systems, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina. FAU - Vassallo, Juan Carlos AU - Vassallo JC AD - Teaching and Research, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina. FAU - Landry, Luis Martin AU - Landry LM AD - PICU, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina. FAU - Garcia-Elorrio, Ezequiel AU - Garcia-Elorrio E AD - Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina. LA - eng SI - ClinicalTrials.gov/NCT03924570 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20210423 PL - England TA - BMJ Qual Saf JT - BMJ quality & safety JID - 101546984 CIN - BMJ Qual Saf. 2021 Oct;30(10):769-774. PMID: 33893212 MH - Argentina MH - Child MH - Communication MH - Humans MH - Intensive Care Units MH - Intensive Care Units, Pediatric MH - *Patient Handoff OTO - NOTNLM OT - adverse events OT - critical care OT - epidemiology and detection OT - hand-off OT - paediatrics OT - quality improvement COIS- Competing interests: FJB, LML, MP, GR, NDM, RBP and ISA report grants from the Ministry of Health of the Nation, through the Directorate of Research for Health, Argentine, during the conduct of the study. EDAT- 2021/04/25 06:00 MHDA- 2021/10/28 06:00 CRDT- 2021/04/24 05:40 PHST- 2020/09/14 00:00 [received] PHST- 2021/03/28 00:00 [revised] PHST- 2021/04/07 00:00 [accepted] PHST- 2021/04/25 06:00 [pubmed] PHST- 2021/10/28 06:00 [medline] PHST- 2021/04/24 05:40 [entrez] AID - bmjqs-2020-012370 [pii] AID - 10.1136/bmjqs-2020-012370 [doi] PST - ppublish SO - BMJ Qual Saf. 2021 Oct;30(10):782-791. doi: 10.1136/bmjqs-2020-012370. Epub 2021 Apr 23.