Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial

Autores
Jorro Baron, Facundo Ariel; Suarez Anzorena, Inés; Burgos Pratx, Rodrigo; De Maio, Noelia; Penazzi, Matiás; Rodriguez, Ana Paula; Rodriguez, Gisela; Velardez, Daniel; Gibbons, Luz; Ábalos, Silvina; Lardone, Silvina; Gallagher, Rosario; Olivieri, Joaquín; Rodriguez, Rocío; Vassallo, Juan Carlos; Landry, Luis Martín; Garcia Elorrio, Ezequiel
Año de publicación
2021
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
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.
Fil: Jorro Baron, Facundo Ariel. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Suarez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Burgos Pratx, Rodrigo. Gobierno de la Provincia de Jujuy. Hospital Materno Infantil Doctor Hector Quintana; Argentina
Fil: De Maio, Noelia. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Penazzi, Matiás. Municipalidad de la Matanza (Buenos Aires). Hospital Municipal del Niño de San Justo; Argentina
Fil: Rodriguez, Ana Paula. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Rodriguez, Gisela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina
Fil: Velardez, Daniel. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Ábalos, Silvina. Gobierno de la Provincia de Jujuy. Hospital Materno Infantil Doctor Hector Quintana; Argentina
Fil: Lardone, Silvina. Municipalidad de la Matanza (Buenos Aires). Hospital Municipal del Niño de San Justo; Argentina
Fil: Gallagher, Rosario. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Olivieri, Joaquín. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina
Fil: Rodriguez, Rocío. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vassallo, Juan Carlos. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Landry, Luis Martín. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina
Materia
ADVERSE EVENTS
CRITICAL CARE
EPIDEMIOLOGY AND DETECTION
HAND-OFF
PAEDIATRICS
QUALITY IMPROVEMENT
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/165447
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/165447
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trialJorro Baron, Facundo ArielSuarez Anzorena, InésBurgos Pratx, RodrigoDe Maio, NoeliaPenazzi, MatiásRodriguez, Ana PaulaRodriguez, GiselaVelardez, DanielGibbons, LuzÁbalos, SilvinaLardone, SilvinaGallagher, RosarioOlivieri, JoaquínRodriguez, RocíoVassallo, Juan CarlosLandry, Luis MartínGarcia Elorrio, EzequielADVERSE EVENTSCRITICAL CAREEPIDEMIOLOGY AND DETECTIONHAND-OFFPAEDIATRICSQUALITY IMPROVEMENThttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background 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.Fil: Jorro Baron, Facundo Ariel. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Suarez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Burgos Pratx, Rodrigo. Gobierno de la Provincia de Jujuy. Hospital Materno Infantil Doctor Hector Quintana; ArgentinaFil: De Maio, Noelia. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Penazzi, Matiás. Municipalidad de la Matanza (Buenos Aires). Hospital Municipal del Niño de San Justo; ArgentinaFil: Rodriguez, Ana Paula. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Rodriguez, Gisela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Velardez, Daniel. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Ábalos, Silvina. Gobierno de la Provincia de Jujuy. Hospital Materno Infantil Doctor Hector Quintana; ArgentinaFil: Lardone, Silvina. Municipalidad de la Matanza (Buenos Aires). Hospital Municipal del Niño de San Justo; ArgentinaFil: Gallagher, Rosario. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Olivieri, Joaquín. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Rodriguez, Rocío. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Vassallo, Juan Carlos. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Landry, Luis Martín. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaBMJ Publishing Group2021-10info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/165447Jorro Baron, Facundo Ariel; Suarez Anzorena, Inés; Burgos Pratx, Rodrigo; De Maio, Noelia; Penazzi, Matiás; et al.; Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial; BMJ Publishing Group; BMJ Quality and Safety; 30; 10; 10-2021; 782-7912044-5415CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1136/bmjqs-2020-012370info:eu-repo/semantics/altIdentifier/url/https://qualitysafety.bmj.com/content/30/10/782info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-10-15T15:06:44Zoai:ri.conicet.gov.ar:11336/165447instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-10-15 15:06:44.939CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
title Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
spellingShingle Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
Jorro Baron, Facundo Ariel
ADVERSE EVENTS
CRITICAL CARE
EPIDEMIOLOGY AND DETECTION
HAND-OFF
PAEDIATRICS
QUALITY IMPROVEMENT
title_short Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
title_full Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
title_fullStr Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
title_full_unstemmed Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
title_sort Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial
dc.creator.none.fl_str_mv Jorro Baron, Facundo Ariel
Suarez Anzorena, Inés
Burgos Pratx, Rodrigo
De Maio, Noelia
Penazzi, Matiás
Rodriguez, Ana Paula
Rodriguez, Gisela
Velardez, Daniel
Gibbons, Luz
Ábalos, Silvina
Lardone, Silvina
Gallagher, Rosario
Olivieri, Joaquín
Rodriguez, Rocío
Vassallo, Juan Carlos
Landry, Luis Martín
Garcia Elorrio, Ezequiel
author Jorro Baron, Facundo Ariel
author_facet Jorro Baron, Facundo Ariel
Suarez Anzorena, Inés
Burgos Pratx, Rodrigo
De Maio, Noelia
Penazzi, Matiás
Rodriguez, Ana Paula
Rodriguez, Gisela
Velardez, Daniel
Gibbons, Luz
Ábalos, Silvina
Lardone, Silvina
Gallagher, Rosario
Olivieri, Joaquín
Rodriguez, Rocío
Vassallo, Juan Carlos
Landry, Luis Martín
Garcia Elorrio, Ezequiel
author_role author
author2 Suarez Anzorena, Inés
Burgos Pratx, Rodrigo
De Maio, Noelia
Penazzi, Matiás
Rodriguez, Ana Paula
Rodriguez, Gisela
Velardez, Daniel
Gibbons, Luz
Ábalos, Silvina
Lardone, Silvina
Gallagher, Rosario
Olivieri, Joaquín
Rodriguez, Rocío
Vassallo, Juan Carlos
Landry, Luis Martín
Garcia Elorrio, Ezequiel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv ADVERSE EVENTS
CRITICAL CARE
EPIDEMIOLOGY AND DETECTION
HAND-OFF
PAEDIATRICS
QUALITY IMPROVEMENT
topic ADVERSE EVENTS
CRITICAL CARE
EPIDEMIOLOGY AND DETECTION
HAND-OFF
PAEDIATRICS
QUALITY IMPROVEMENT
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv 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.
Fil: Jorro Baron, Facundo Ariel. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Suarez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Burgos Pratx, Rodrigo. Gobierno de la Provincia de Jujuy. Hospital Materno Infantil Doctor Hector Quintana; Argentina
Fil: De Maio, Noelia. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Penazzi, Matiás. Municipalidad de la Matanza (Buenos Aires). Hospital Municipal del Niño de San Justo; Argentina
Fil: Rodriguez, Ana Paula. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Rodriguez, Gisela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina
Fil: Velardez, Daniel. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Ábalos, Silvina. Gobierno de la Provincia de Jujuy. Hospital Materno Infantil Doctor Hector Quintana; Argentina
Fil: Lardone, Silvina. Municipalidad de la Matanza (Buenos Aires). Hospital Municipal del Niño de San Justo; Argentina
Fil: Gallagher, Rosario. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Olivieri, Joaquín. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina
Fil: Rodriguez, Rocío. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vassallo, Juan Carlos. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Landry, Luis Martín. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina
description 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.
publishDate 2021
dc.date.none.fl_str_mv 2021-10
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/165447
Jorro Baron, Facundo Ariel; Suarez Anzorena, Inés; Burgos Pratx, Rodrigo; De Maio, Noelia; Penazzi, Matiás; et al.; Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial; BMJ Publishing Group; BMJ Quality and Safety; 30; 10; 10-2021; 782-791
2044-5415
CONICET Digital
CONICET
url http://hdl.handle.net/11336/165447
identifier_str_mv Jorro Baron, Facundo Ariel; Suarez Anzorena, Inés; Burgos Pratx, Rodrigo; De Maio, Noelia; Penazzi, Matiás; et al.; Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: A stepped-wedge trial; BMJ Publishing Group; BMJ Quality and Safety; 30; 10; 10-2021; 782-791
2044-5415
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.1136/bmjqs-2020-012370
info:eu-repo/semantics/altIdentifier/url/https://qualitysafety.bmj.com/content/30/10/782
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.22299

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