Transition To Residency · Year 4 · from Transition To Residency
Case 1: I-PASS Handoff Preventing Adverse Event
Clinical Image
Source: Wikipedia - Handover (medicine) - CC BY-SA 4.0
Case Presentation
A 28-year-old female internal medicine intern is signing out a 58-year-old male patient with acute decompensated heart failure to the night float team. Using the I-PASS framework, she communicates: Illness severity: "Watcher - he's been improving but had an episode of atrial fibrillation with rapid ventricular response this afternoon." Patient summary: "58-year-old male with ischemic cardiomyopathy, EF 25%, admitted for CHF exacerbation, now net negative 3 liters on IV diuresis." Action list: "Please check his 10 PM potassium and replete if below 4.0 given his rhythm issues; I/O at midnight." Situation awareness and contingency: "If he goes back into afib with RVR, he responded to IV metoprolol 5mg; if hypotensive with afib, please call cardiology fellow - their number is on the list." Synthesis: The night intern reads back the key points. At 11 PM, the patient develops rapid atrial fibrillation. Because of the detailed handoff, the covering intern immediately administers metoprolol and the patient converts to sinus rhythm. Without the specific contingency plan and medication information, there might have been significant delay in treatment.
Key Learning Points
- The I-PASS framework (Illness severity, Patient summary, Action list, Situation awareness/contingency, Synthesis) provides a structured method for complete, safe handoffs
- Situation awareness with explicit if-then contingency planning prepares covering physicians to respond appropriately to anticipated clinical changes
- Synthesis through receiver read-back confirms accurate information transfer and provides opportunity to correct misunderstandings