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Mnemonics Can Help Organize Handoffs

A simple tool for improving patient safety and care handoffs is to use mnemonics.

In case management, these can be a tool for remembering specific actions with patients and care transitions.1

For example, one useful mnemonic is SAIF-IR, which stands for summary, active issues, if-then contingency planning, follow-up activities, interactive questioning, and readback. This mnemonic ensures active and uniform handoffs.2

“It’s a tool we use to observe and assess the quality of handoffs,” says Heidi Kenaga, PhD, a research coordinator in the office of graduate medical education at Wayne State University School of Medicine in Detroit.

Wayne State faculty use mnemonics when training residents. “It’s broken down by how well they do each component of the mnemonic,” Kenaga says.

Handoff Mnemonics Recommended

The Accreditation Council for Graduate Medical Education (ACGME), which oversees residency training in the United States, encourages the use of handoff mnemonics.

ACGME developed six core competencies for all residents, which can be described in the mnemonic SIMPLE:

  • Systems-based practice;
  • Interpersonal skills and communication;
  • Medical knowledge;
  • Patient care;
  • Learning (practice-based and improvement);
  • Etiquette.3

Healthcare professionals often rush to complete tasks and transition patients. It can be easy to forget a specific action.

“It’s been known for a while that a bad handoff creates problems,” Kenaga says. “But when ACGME started researching all of this, they realized that handoffs needed to be in a set process.”

When case management leaders train new case managers, they can use mnemonics to ensure the new employees are performing tasks correctly.

Like other new hospital staff, residents will follow the direction indicated by the people training them. If the leaders/trainers do not take certain processes seriously, then neither will the new staff or residents.

“If you’re not pinpointing where errors usually occur to ensure mechanisms for patient safety, residents will follow the lead of faculty. We needed to show that very safe handoffs are very, very important,” Kenaga explains. “Someone is watching you do something, and you see it is assessed and will be reported. You can go on YouTube and find tutorials and primers on how not to do the handoff.”

The videos will demonstrate a good handoff in which there is a face-to-face meeting with the resident and the person receiving the information. “Someone is taking notes, and they follow the mnemonic to make sure they’re following all bases,” Kenaga adds. “We did this to cover all elements of the summary active issues.” The Wayne State University Office of Graduate Medical Education created a transitions of care direct observation tool to monitor residents’ knowledge and skills in using SAIF-IR.2

A Few Drawbacks

One of the drawbacks to mnemonics is people might forget what each letter means if they are too long. There is scant evidence they affect handoffs and patient errors, Kenaga says. One randomized, controlled trial showed implementation of a mnemonic to standardize oral and written handoffs was associated with reductions in medical errors and preventable adverse events. It also was found to improve communication.4

“A lot of people have published on mnemonics and how to make sure people are using it correctly,” she adds. “But pushing it that extra step to show it reduces errors in patient outcomes, there’s only the one study.”

Using mneumonics is a formalized way to help people remember steps and to ensure they do not forget anything. One of the more popular patient transition mnemonics is I-PASS:

  • Illness severity;
  • Patient information;
  • Action list;
  • Situational awareness and contingency plans;
  • Synthesis by receiver.5

I-PASS is used in a variety of settings and by different healthcare professionals, including nurses and physicians. Clinicians across most handoff settings said using the mnemonic improved their handoff performance.5

“I was surprised to find that I-PASS is the most popular one,” Kenaga says. But it could be that after hours of patient handoffs, something that is simple and intuitive like “I pass the patient off to you” could be just what clinicians want, she adds.

REFERENCES

  1. Kerwin J. The benefits of nursing mnemonics. Excelsior College. June 26, 2018.
  2. Kenaga H, Markova T, Stansfield RB, et al. Using a direct observation tool (TOC-CEX) to standardize transitions of care by residents at a community hospital. Ochsner J 2021;21:381-386.
  3. Remembering the ACGME 6 Core Competencies by a SIMPLE mnemonic. CasesBlog. March 25, 2008.
  4. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med 2014;37:1803-1812.
  5. Blazin LJ, Sitthi-Amorn J, Hoffman JM, Burlison JD. Improving patient handoffs and transitions through adaptation and implementation of I-PASS across multiple handoff settings. Pediatr Qual Saf 2020;5:e323.