166 - Handover Your Patients The Right Way: A Resident-Led Implementation of an I-PASS–Based EMR Sign-Out Tool

Publication Number: 3160.166

Emmy Kristine Trinidad, BronxCare Health System, Bronx, NY, United States; Yossef Alnasser, BronxCare Health System, New York, NY, United States; Savita Manwani, Bronx Care Health System, Bronx, NY, United States

Background: Inefficient and inconsistent handoffs are a well-documented source of communication errors and workflow burden in pediatric inpatient care. At our institution, residents relied on manual, non-standardized sign-out sheets that could compromise patient care. To address this, we developed and implemented an Electronic Medical Record (EMR)-integrated handoff tool based on the I-PASS framework to standardize and streamline patient handoffs.

Objective: To improve resident-reported satisfaction, accuracy, and efficiency of pediatric inpatient handoffs through implementation of an I-PASS-based EMR sign-out tool within six months.

Design/Methods: A baseline needs assessment was conducted in December 2024 (n=22) to identify challenges with the manual sign-out. Pre- and post-implementation surveys evaluated the process, outcome, and balancing measures of the handoff tool. The process measure was EMR handoff tool utilization. Outcome measures included resident-reported satisfaction, perceived efficiency, and accuracy of information. The balancing measure assessed the perceived time burden of updates. Free-text responses were qualitatively analyzed for common themes.

Results: Responses from the baseline survey identified key challenges with the manual sign-out, including lack of standardization (55%), incomplete information (59%), and excessive time burden (59%), with the majority also finding the manual process burdensome. After the pilot phase, the I-PASS-based EMR tool achieved 100% adoption, fully replacing the manual sign-out with support from faculty and residents. Post-implementation (n=22), all residents reported increased efficiency with the EMR tool; 86% rated it as much more efficient, 77% noted greatly improved handoffs, and 82% reported fewer communication errors. Resident satisfaction markedly increased from 59% to 95% over 3 months, and 91% found the tool highly user-friendly. Time spent updating sign-outs decreased from over 30 minutes per shift for 55% of residents to 5-10 minutes for 77% over 3 months. Qualitative short interviews highlighted improved accessibility, streamlined documentation, and enhanced daily workflow with reduced potential for medical errors.

Conclusion(s): A resident-led, I-PASS-based EMR-integrated handoff tool standardized pediatric inpatient handoffs, improved communication efficiency, and enhanced resident satisfaction while reducing documentation time. Following its success on the pediatric floor, the tool has been expanded to the NICU and is being adopted hospital-wide to integrate both medical and surgical services.

Figure 1. PDSA Cycle for EMR Sign-Out Tool Implementation
Plan-Do-Study-Act framework applied iteratively to improve inpatient handoffs.

Figure 2. Resident Satisfaction, Accuracy, and Efficiency of Inpatient Handoffs
Resident-reported satisfaction (59→95%), accuracy (42→91%), and efficiency (24→100%) improved after EMR sign-out implementation (n = 22 pre, 22 post).

Figure 3. Time Spent Updating Sign-Outs
Average sign-out update time dropped from 29 to 7 minutes per shift (−77%).