Say the Numbers Back: Adapting I-PASS for Handoffs From Interventional Radiology to Inpatient Units, With a Pilot on Two Floors
Student Name
American College of Education
NUR5123: Relationships Through Communication
Module 2 Assignment
Instructor Name
July 13, 2027
The Recurring Exchange
The interventional radiology department at the composite hospital introduced in Module 1 returns about 14 inpatients a day to their units after procedures such as biopsies, drain placements, central line insertions and embolizations. Each return involves a telephone report from an interventional radiology nurse to a receiving nurse, and each carries procedure-specific instructions: how often to check vital signs and the puncture site, how long the patient must lie flat, when anticoagulants may resume and what signs should prompt a call. None of this is standardized. A two-week audit of 60 handoffs by the interventional radiology nurse manager found that a monitoring schedule with numbers was stated in 22 calls, the receiving nurse repeated any part of the plan in 9, and written post-procedure instructions reached the receiving unit's record before the patient arrived in 31.
The event analyzed in Module 1, in which a patient bled after a liver biopsy while being monitored every four hours instead of every 15 minutes, was not an exception. It was this exchange working as it usually works, on a day when the patient's risk made the gap matter. The Joint Commission (2017) has identified inadequate handoff communication as a contributing factor in many of the serious adverse events reported to it and calls for standardized, interactive handoffs in which the receiver can ask questions.
Choosing the Tool
Two tools were considered. SBAR, which organizes a message into situation, background, assessment and recommendation, is widely used in the hospital for calls from nurses to physicians. A systematic review of 11 studies judged the evidence of a safety benefit from SBAR to be moderate, particularly when used to structure telephone communication, although the studies were heterogeneous and reported 26 different outcomes (Müller et al., 2018).
I-PASS takes its name from its five parts: the patient's illness severity, a brief summary, an action list, awareness of what could change with a plan for it, and a closing synthesis spoken by the receiver. In a study of residents' handoffs across nine pediatric residency programs, its implementation was followed by fewer medical errors and fewer preventable adverse events in the period after the change, reductions of roughly a quarter and nearly a third, while spoken handoffs took no longer than before (Starmer et al., 2014). That study involved physicians handing off at shift change, not nurses handing off after procedures, so its results cannot be assumed to transfer directly.
I-PASS was chosen because of its final element. Module 1 traced the failure to the relationship between the two nurses, in which a clarifying question would have sounded like an admission of not knowing. Synthesis by the receiver makes the receiving nurse's summary a required step rather than a question. A read-back that everyone must do protects the person who needed to ask, because no one can tell which receiver needed it. The action list and contingency elements also fit procedural handoffs, which are mostly about what to do in the next few hours and what to do if something goes wrong.
The Adapted Tool
The adapted handoff, which staff named IR-PASS during the design sessions, keeps the five I-PASS elements and adds two features. First, before the call, the interventional radiology nurse files a procedure-specific monitoring order set in the record, so the receiving nurse sees the schedule in writing when the call begins. Second, the synthesis step requires the receiving nurse to state the monitoring intervals, the activity restriction and the call criteria in numbers, and the interventional radiology nurse confirms or corrects them.
Applied to the Module 1 patient, the handoff would sound like this. Illness severity: stable, higher bleeding risk because of low-normal platelets and recent heparin. Patient summary: CT-guided biopsy of a right liver lobe lesion, 18-gauge needle, three passes, no immediate bleeding seen on the post-procedure images. Action list: vital signs every 15 minutes for one hour, every 30 minutes for two hours, then hourly for four hours; bed rest on the right side for four hours; heparin held until tomorrow morning unless the team decides otherwise. Situation awareness and contingency: call interventional radiology and the primary team if the systolic reading drops under 100 or the pulse climbs past 110, new right upper quadrant or shoulder pain, or a hemoglobin drop on the evening check. Synthesis: the receiving nurse repeats the intervals, the bed rest and the call criteria, and the interventional radiology nurse confirms.
Staff in both departments helped design the wording. The oncology nurses asked that the call criteria always include numbers; the interventional radiology nurses asked that the receiving nurse be free to answer the call when not in the middle of a medication, with a callback within ten minutes, so that reports are not given to someone preparing chemotherapy.
The Pilot
The tool will be piloted for eight weeks between interventional radiology and two inpatient units, oncology and a medical-surgical unit, which together receive about a third of the department's inpatients. Training consists of a 20-minute session for every nurse in the three areas, a pocket card and two practice handoffs with a colleague. Nurse champions in each area will coach peers during the first two weeks.
Three measures will be tracked. The primary process measure is the percentage of handoffs in which the receiving nurse reads back the monitoring intervals in numbers, measured by an interventional radiology nurse listening to a random sample of 20 calls each week on speaker with both nurses' knowledge. The second is the percentage of patients whose first post-procedure vital signs on the unit are taken within the ordered interval, drawn from the record. The third is any unplanned transfer to intensive care or rapid response call within 12 hours of a procedure, reviewed case by case. Riesenberg et al. (2010) found that few studies of nursing handoffs measured whether handoffs were effective, which is why the pilot measures outcomes as well as whether the steps were followed.
The team agreed its decision rule before the first call. If read-back occurs in at least 80% of sampled calls and on-time first vital signs rise above 90% by week eight, the tool will extend to all inpatient units. If read-back is high but vital signs remain late, the problem lies downstream of the handoff, in unit workload or the order set, and will be examined before the tool is extended.
What the Tool Cannot Fix
A structured handoff improves what is said, but it cannot guarantee what happens next. If the oncology unit has five patients per nurse and one of them is receiving chemotherapy, a monitoring schedule of every 15 minutes may be read back perfectly and still be missed. For that reason the adapted order set places the post-procedure vital sign intervals on the unit's task list with alerts, and the pilot's second measure watches for exactly this gap. The tool also cannot repair the relationship between the two departments on its own. It makes one conversation safer, but the managers' meeting described in Module 1, and the regular joint review of any post-procedure complication that both units have agreed to, are what will change how the two groups see each other. The next module plans one of the harder conversations that this work requires.
References
Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), Article e022202. https://doi.org/10.1136/bmjopen-2018-022202
Riesenberg, L. A., Leitzsch, J., & Cunningham, J. M. (2010). Nursing handoffs: A systematic review of the literature. American Journal of Nursing, 110(4), 24-34. https://doi.org/10.1097/01.NAJ.0000370154.79857.09
Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., ... Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812. https://doi.org/10.1056/NEJMsa1405556
The Joint Commission. (2017). Inadequate hand-off communication (Sentinel Event Alert, Issue 58). https://www.jointcommission.org/resources/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-58-inadequate-hand-off-communication/
How this NUR 5123 Module 2 example is structured
NUR 5123 Module 2 often applies a structured tool such as SBAR or TeamSTEPPS to a recurring interprofessional exchange; your classroom's instructions decide which tool and whether a pilot or script is required. This example describes the recurring exchange and its failures, compares candidate tools against evidence and the local problem, shows the adapted tool with a worked example, and plans the pilot with training, measures and a decision rule.
NUR5123 Module 2 questions, answered
What does NUR5123 Module 2 usually ask for?
NUR5123 Module 2 often asks you to apply a structured communication tool, such as SBAR, I-PASS or a TeamSTEPPS tool, to a recurring interprofessional exchange in your setting and explain how it would improve communication. Your classroom's instructions decide the tool and whether a pilot plan is required.
Should I choose SBAR or I-PASS?
Choose the tool that fixes the failure you found. SBAR suits escalation calls to a provider; I-PASS suits handoffs where the receiver must take over a plan, because it ends with the receiver's synthesis. Explain your reasoning with evidence.
How do I show the tool would work?
Give a worked example using a real or composite case, then plan a small pilot with process and outcome measures and a decision rule for whether to extend it.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.