IPASS Integrating High Quality Handoffs into Team STEPPS

I-PASS: Integrating High Quality Handoffs into Team. STEPPS and Hospital Care May 13, 2015

I-PASS Team. STEPPS® Rules of Engagement n Audio for the webinar can be accessed in two ways: 1. Through the phone (*Please mute your computer speakers) 2. Through your computer n A Q&A session will be held at the end of the presentation n Written questions are encouraged throughout the presentation and will be answered during the Q&A session n To submit a question, type it into the Chat Area and send it at any time during the presentation n The lines may open for call-in questions during the Q&A session Mod 1 05. 2 Page 2 Slide 2 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Acknowledgements n Project Sponsors n n Jim Battles, Ph. D (AHRQ) Heidi King, MS (Do. D) n Project Team n n Mod 1 05. 2 Page 3 Slide 3 Health Research & Educational Trust (HRET) n Barb Edson (Project Director) n Chris Hund (Project Manager) IMPAQ International n David Baker (Team Lead) TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Team. STEPPS Master Training n Two-day training course n Train-the-trainer approach n Prepares you to serve as a Team. STEPPS Master Trainer by n n Providing instruction on Team. STEPPS tools and strategies Providing an opportunity to develop and plan your Team. STEPPS implementation n Prepares you to serve as a leader for implementing Team. STEPPS within your organization Mod 1 05. 2 Page 4 Slide 4 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Upcoming Team. STEPPS Events n Monthly Webinars n Scheduled through September 2015 n Topics, speakers, and registration information will be posted on the portal n Master Training Courses n Registration available for courses through August 2015 n Annual Conference n June 16 -18, 2015 n Denver, Colorado at the Westin Downtown Denver n Learn more and register for all events at www. Team. STEPPSportal. org Mod 1 05. 2 Page 5 Slide 5 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Help Line (312) 422 -2609 Or email: AHRQTeam. STEPPS@aha. org Mod 1 05. 2 Page 6 Slide 6 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Today’s Presenters n Christopher P. Landrigan, MD, MPH n n Research Director, Inpatient Pediatrics Service, Boston Children’s Hospital Director, Sleep and Patient Safety Program, Brigham and Women’s Hospital Associate Professor of Medicine and Pediatrics, Harvard Medical School Principal Investigator, I-PASS Study n Clifton E. Yu, MD n n Mod 1 05. 2 Page 7 Slide 7 Director of Graduate Medical Education, Walter Reed National Military Medical Center Associate Professor of Pediatrics, Uniformed Services University of the Health Sciences TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Objectives n Review the literature on handoffs, miscommunications, and patient safety n Describe I-PASS and the study design n Discuss the results of a multi-center study in 9 North American hospitals Mod 1 05. 2 Page 8 Slide 8 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Disclosures n Dr. Landrigan has consulted with multiple academic medical centers regarding work schedule design and handoff programs n The presentation will not involve discussion of unapproved or off-label, experimental or investigational use n The presentation will show copyrighted materials for which permission has been obtained from Boston Children’s Hospital and the I-PASS Study Group Mod 1 05. 2 Page 9 Slide 9 TEAMSTEPPS 05. 2

Team. STEPPS® I-PASS Patient Safety in the US: Ongoing Problems n Institute of Medicine, 1999 n 44, 000 -98, 000 deaths per year due to adverse events n Office of the Inspector General, 2010 n 180, 000 deaths per year due to adverse events n North Carolina Patient Safety Study, 2010 n 2341 randomly selected admissions from 10 randomly selected hospitals statewide Mod 1 05. 2 Page 10 Slide 10 Landrigan NEJM 2010: 363: 2124 -34 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Intern Sleep and Patient Safety Study n Randomized Controlled Trial of extended shifts (24 -30 h) vs. 16 h limit Mod 1 05. 2 Page 11 Slide 11 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Shorter Shifts - Increased Frequency of Handoffs n 2008 IOM Report on Resident Duty Hours concluded that it was unsafe for residents to work more than 16 hours without sleep n 2011 ACGME Duty Hour Standards restricted interns to 16 consecutive hours of work and requires programs to: n n Ensure and monitor structured handoffs Teach resident handoff skills and ensure competence © 2013 I-PASS Study Group/Boston Children's Hospital All Rights Reserved. For Permissions contact ipass. study@childrens. harvard. edu Mod 1 05. 2 Page 12 Slide 12 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Communication Failures are the Leading Cause of Sentinel Events in Hospitals Percentage of Sentinel Events involving various Root Causes (Joint Commission 2006) Mod 1 05. 2 Page 13 Slide 13 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Video Example of Poor Patient Care Handoff Mod 1 05. 2 Page 14 Slide 14 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Elements of the Sign-out Mod 1 05. 2 Page 15 Slide 15 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Handoff Bundle Intervention: Boston Children’s Hospital n Resident handoff bundle (RHB): n n Communication and handoff skills training Mnemonic Redesigned verbal handoff process Computerized handoff tool (Unit 1 only) Starmer AJ, Sectish TC, Simon DW, Keohane C, Mc. Sweeney ME, Chung EY, Yoon CS, Lipsitz SR, Wassner AJ, Harper MB, Landrigan CP. JAMA 2013; 310: 2262 -2270 Mod 1 05. 2 Page 16 Slide 16 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Results: Medical Error and Preventable Adverse Events Rates per 100 Admissions Pre. RHB Post. RHB p-value Medical Errors 33. 8 18. 3 <0. 001 Preventable Adverse Events 3. 3 1. 5 0. 04 Starmer AJ, Sectish TC, Simon DW, Keohane C, Mc. Sweeney ME, Chung EY, Yoon CS, Lipsitz SR, Wassner AJ, Harper MB, Landrigan CP. JAMA 2013; 310: 2262 -2270 Mod 1 05. 2 Page 17 Slide 17 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Pilot Intervention Study: Key Limitations n Single Site Study n Resident learning over time / other confounding factors n Use of mnemonic not sustained following research period Mod 1 05. 2 Page 18 Slide 18 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® From Pilot Study to Multi-center Intervention Project… IIPE-PRIS Accelerating Safe Sign-outs n Multisite study to implement refined handoff bundle for resident physician change of shift handoffs at 9 pediatric institutions Mod 1 05. 2 Page 19 Slide 19 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS: DEVELOPING THE INTERVENTION Mod 1 05. 2 Page 20 Slide 20 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Intervention: More Than Just a Mnemonic I-PASS Handoff Bundle Components Mod 1 05. 2 Page 21 Slide 21 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Team Training The Team. STEPPSTM Model Mod 1 05. 2 Page 22 Slide 22 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Team. STEPPSTM Team Strategies and Tools to Enhance Performance and Patient Safety n Evidence-based team training curriculum n High performing teams n Must have effective leaders n Use structured communication strategies n Develop situational awareness n Provide mutual support Mod 1 05. 2 Page 23 Slide 23 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Multi-Team System Mod 1 05. 2 Page 24 Slide 24 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Building a Shared Mental Model Mod 1 05. 2 Page 25 Slide 25 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Structured Team Communication Techniques Technique Function Brief Plan team activities Debrief Analyze an interim event Huddle Solve a problem Cross monitoring / Improve performance Feedback Mod 1 05. 2 Page 26 Slide 26 Assertive statement Identify potential errors Check-back Ensure accurate information transfer Handoff Transfer care and responsibility TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Brief Essential to Team Planning n Engages team members in short-term planning n Provides a “pre-game” team meeting Mod 1 05. 2 Page 27 Slide 27 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Brief Mod 1 05. 2 Page 28 Slide 28 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Debrief Essential to Improvement n Improves teamwork skills and patient outcomes n Reconstructs and analyzes interim events Mod 1 05. 2 Page 29 Slide 29 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Debrief Mod 1 05. 2 Page 30 Slide 30 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Huddle Essential to Solve Problems n Is an opportunity to touch base and regain situation awareness n Focuses on critical issues and emerging events Mod 1 05. 2 Page 31 Slide 31 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Huddle Mod 1 05. 2 Page 32 Slide 32 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Feedback Essential for Cross Monitoring n Focuses on team performance and improvement n Provides a learning opportunity Mod 1 05. 2 Page 33 Slide 33 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Cross-Monitoring/Feedback Mod 1 05. 2 Page 34 Slide 34 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Advocacy and Assertion Strategy for Avoiding Errors n When viewpoints differ n Advocate for the patient n Make assertive statement n n Mod 1 05. 2 Page 35 Slide 35 Open the discussion State the concern Offer a solution Obtain an agreement TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Advocacy and Assertion Mod 1 05. 2 Page 36 Slide 36 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Check-Back Mod 1 05. 2 Page 37 Slide 37 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Structured Team Communication Techniques Mod 1 05. 2 Page 38 Slide 38 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Global Elements of Effective Handoffs n Effective handoffs Ensure transfer of accurate & unambiguous information n Facilitate transfer of responsibility n May be supervised n Ensure quality n Provide feedback n Verbal handoffs n Utilize standardized format n Employ closed-loop communication n Printed handoff documents n Supplement verbal handoff n Mod 1 05. 2 Page 39 Slide 39 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® The I-PASS Mnemonic Mod 1 05. 2 Page 40 Slide 40 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS Study I P A S S Mod 1 05. 2 Page 41 Slide 41 Illness Severity Patient Summary Action List Situation Awareness & Contingency Planning Synthesis by Receiver TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Illness Severity – A Continuum n Watcher : any clinician’s “gut feeling” that a patient is at risk of deterioration or “close to the edge” Mod 1 05. 2 Page 42 Slide 42 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS Study I P A S S Mod 1 05. 2 Page 43 Slide 43 Illness Severity Patient Summary Action List Situation Awareness & Contingency Planning Synthesis by Receiver TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Sections of a Patient Summary n Summary statement n Events leading up to admission n Hospital course n Ongoing assessment n Organized by problems/diagnoses n Plan n Organized by problems/diagnoses Mod 1 05. 2 Page 44 Slide 44 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® High Quality Patient Summaries n Create a shared mental model n Facilitate the transfer of information and responsibility n Transmit information concisely n Describe unique features of the patient’s presentation n Use semantic qualifiers Mod 1 05. 2 Page 45 Slide 45 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Semantic Qualifiers n Dichotomous qualifiers along an axis n n Provide clarity Enable clear communication of representative clinical features n Examples n Onset – acute, sub-acute, chronic n Site – proximal, distal n Course – intermittent, progressive n Severity – mild, moderate, severe n Quality – burning, dull, sharp n Context – nocturnal, at rest n Patient Characteristics – female, infant, adolescent Mod 1 05. 2 Page 46 Slide 46 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS Study I P A S S Mod 1 05. 2 Page 47 Slide 47 Illness Severity Patient Summary Action List Situation Awareness & Contingency Planning Synthesis by Receiver TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Action List Mod 1 05. 2 Page 48 Slide 48 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS Study I P A S S Mod 1 05. 2 Page 49 Slide 49 Illness Severity Patient Summary Action List Situation Awareness & Contingency Planning Synthesis by Receiver TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Situation Awareness Team Level Patient Level n “Know what is going on n “Know what’s going on around you” n Status of patients n Team members n Environment n Progress toward team goals Mod 1 05. 2 Page 50 Slide 50 TEAMSTEPPS 05. 2 with your patient” n Status of patient’s disease process n Team members’ roles in patient’s care n Environmental factors n Progress toward goals of hospitalization

I-PASS Team. STEPPS® Contingency Planning n Problem solving before things go wrong n “If this happens, then…” Mod 1 05. 2 Page 51 Slide 51 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS Study I P A S S Mod 1 05. 2 Page 52 Slide 52 Illness Severity Patient Summary Action List Situation Awareness & Contingency Planning Synthesis by Receiver TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Synthesis by Receiver n Provides an opportunity for receiver to n Clarify elements of handoff Ensure there is a clear understanding n Have an active role in handoff process n n Varies in length and content More complex, sicker patients require more detail n At times may focus more on action items, contingency planning n n It is not a re-stating of entire verbal handoff! Mod 1 05. 2 Page 53 Slide 53 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® The Printed Handoff Document n Supplements the verbal handoff n Allows receiver to follow n Provides more comprehensive information n Creates efficient information transfer n Requires daily updates n High-quality information n n Mod 1 05. 2 Page 54 Slide 54 Don’t copy and paste Senior/supervising resident should edit and ensure quality TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Overview of 3 -hour Workshop 2 -Hour Session of Didactic and Interactive Exercises 1 -Hour Handoff Simulation Exercise n Team. STEPPS training n Communication skills n Briefs, debriefs, huddles n 3 Role Play Scenarios that will allow residents the opportunity to be n Learning styles exercise n n Handoff skills training n Verbal Mnemonic n Written Handoff Document n Mod 1 05. 2 Page 55 Slide 55 TEAMSTEPPS 05. 2 n Giver Receiver Observer n 1 Role Play Scenario n Developing a Shared Mental Model

I-PASS Team. STEPPS® Faculty Training Workshop n 1 -hour workshop n n Mod 1 05. 2 Page 56 Slide 56 Brief introduction to I-PASS study Review of I-PASS handoff techniques Introduction to the observation tools Video simulations of resident handoffs to allow practice with use of observation tools TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Verbal Handoff Observation Tool-Giver Mod 1 05. 2 Page 57 Slide 57 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Verbal Handoff Observation Tool. Receiver Mod 1 05. 2 Page 58 Slide 58 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Handoff Assessment Tool-Written Mod 1 05. 2 Page 59 Slide 59 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Implementation of Curriculum Institutional Campaign n Logo n Pocket Cards n Posters n Computer screen-surrounds n Flip charts n Tips of the day n Fortune cookies with I-PASS tips inside Mod 1 05. 2 Page 60 Slide 60 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Video Example of Effective Handoff Mod 1 05. 2 Page 61 Slide 61 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® STUDY METHODS Mod 1 05. 2 Page 62 Slide 62 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS Study Objectives n Study Aims: To determine if handoff bundle implementation associated with: n Primary outcome n n Process outcomes n n Improved written and verbal handoff communication Balancing measures n Mod 1 05. 2 Page 63 Slide 63 A significant reduction in overall error rates and preventable adverse events Impact on resident workflow patterns TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Study Design Mod 1 05. 2 Page 64 Slide 64 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Methods - Primary Outcome: Measurement of Error Rates n Standardized error surveillance methodology n Study nurse reviews patient charts n n n Medication orders, MAR, progress notes, nursing notes, and discharge summary Hospital incident reports Daily solicited error reports from physicians n All types and severities of medical errors collected n n Mod 1 05. 2 Page 65 Slide 65 Categorized severity, preventability, type Dual review by blinded physicians TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Methods – Process Outcomes: Verbal and Written Handoff Miscommunications n Audio recordings of evening verbal handoffs n n Random selection of 12 per study period per site Review all patients for presence or absence of 5 key data elements n Electronic copies of printed handoff documents n n Mod 1 05. 2 Page 66 Slide 66 Random selection of 24 handoff documents per study period per site Review all patients for presence or absence of 9 key data elements TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Methods – Balancing Measure: Time Motion Study Mod 1 05. 2 Page 67 Slide 67 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Methods: Statistical Analysis n Error rates n Poisson regression n n Dichotomous covariate for pre- vs. post-intervention Fixed effect for site n Written and verbal handoff and time motion data n Generalized estimating equation z-test n n Mod 1 05. 2 Page 68 Slide 68 Clustering based on date Fixed effect for site TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® RESULTS Mod 1 05. 2 Page 69 Slide 69 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Results - Process Measures: % of Verbal Handoffs with Key Elements Present Mod 1 05. 2 Page 70 Slide 70 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Results - Process Measures: % of Written Handoffs with Key Data Elements Mod 1 05. 2 Page 71 Slide 71 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Results - Primary Outcome: Medical Error Rates Mod 1 05. 2 Page 72 Slide 72 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Results – Balancing Measures: Resident Workflow Mod 1 05. 2 Page 73 Slide 73 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS FOR NURSES Mod 1 05. 2 Page 74 Slide 74 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS for Nurses n As I-PASS rolled out, nursing leadership at BCH interested in standardizing nursing handoffs as well n Approached I-PASS Team about possibility of adapting I-PASS curriculum n Nurse specific training materials, written handoff tool, video vignettes created Mod 1 05. 2 Page 75 Slide 75 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Study #1: Children’s Hospital Association Improvement Collaborative Bigham et al. , Pediatrics 2014; 134: e 572 -579 n Multisite QI study of effects of implementing handoff improvements across institutions n Sites all used different approaches to handoffs n At BCH, I-PASS studied in three settings n n n ICU shift change Admission from ED to wards Admission from OR/PACU to PICUs n Data collected from front line nurses for random sample of handoffs Mod 1 05. 2 Page 76 Slide 76 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Results Bigham et al. , Pediatrics 2014; 134: e 572 -579 n Overall, the 23 hospitals involved saw reduction in handoff related care failures (publication pending) n BCH, using I-PASS, was among the few that achieved maximum score for sustained improvement in results Mod 1 05. 2 Page 77 Slide 77 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® BCH Handoff Related Care Failures Mod 1 05. 2 Page 78 Slide 78 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Study #2: Direct Observation Nurse Handoffs n Random sample of handoffs directly observed pre- vs. post- intervention n Mod 1 05. 2 Page 79 Slide 79 Time motion methodology, with focus on verbal handoff Key elements of handoff pre- vs. post- I-PASS assessed Nurses’ workflow also assessed in detail over the course of the whole 24 -hour cycle (results still being analyzed) TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Quality of Verbal Handoff Preliminary Results Mod 1 05. 2 Page 80 Slide 80 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® DISSEMINATION Mod 1 05. 2 Page 81 Slide 81 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Website www. ipasshandoffstudy. com Mod 1 05. 2 Page 82 Slide 82 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Curricular Materials available online since May 2012 www. ipasshandoffstudy. com Med. Ed. PORTAL 1 of Top 10 Downloaded Resources © 2013 I-PASS Study Group/Boston Children's Hospital All Rights Reserved. For Permissions contact ipass. study@childrens. harvard. edu Mod 1 05. 2 Page 83 Slide 83 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Spread of I-PASS Curriculum: May 2012 – May 2014 Mod 1 05. 2 Page 84 Slide 84 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Use of I-PASS in Additional Settings Mod 1 05. 2 Page 85 Slide 85 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS: New Directions n Society for Hospital Medicine/AHRQ Mentored implementation n 16 pediatric and 16 adult hospitals n Patient and Family Centered I-PASS n Mod 1 05. 2 Page 86 Slide 86 PCORI grant TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® I-PASS Consultation Program n Adaptation of I-PASS implementation in other disciplines n Institution wide I-PASS implementation and pilots Mod 1 05. 2 Page 87 Slide 87 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Funding and Resources n Primary funding n Department of Health and Human Services n Additional funding for I-PASS provided by: n n Oregon Comparative Effectiveness Research K 12 Program, Agency for Healthcare Research and Quality (AHRQ) Medical Research Foundation of Oregon Physician Services Incorporated Foundation (of Ontario) Pfizer (unrestricted medical education grant) n Pediatric Research in Inpatient Settings (PRIS) Network n Initiative for Innovation in Pediatrics Education (IIPE) n Future Directions: AHRQ, PCORI Mod 1 05. 2 Page 88 Slide 88 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Acknowledgements: I-PASS Study Group Mod 1 05. 2 Page 89 Slide 89 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Better handoffs. Safer care. All handoff materials are available at www. ipasshandoffstudy. com © 2011 I-PASS Study Group/Children’s Hospital Boston All Rights Reserved. For Permissions contact ipass. study@childrens. harvard. edu Mod 1 05. 2 Page 90 Slide 90 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Questions and Answers Mod 1 05. 2 Page 91 Slide 91 TEAMSTEPPS 05. 2

I-PASS Team. STEPPS® Thank You! For more information, please contact our team at: AHRQTeam. STEPPS@aha. org Mod 1 05. 2 Page 92 Slide 92 TEAMSTEPPS 05. 2