I-PASS Handoff: The Five Elements, a Worked Example, and the Evidence

This page is for clinicians, nurse educators and patient-safety or quality staff who want to know what an I-PASS handoff contains, what one sounds like, and what the published studies do and do not show. It is general information about a communication tool, not medical advice and not a clinical protocol. The tool is often searched as “IPASS handoff”, without the hyphen.

What I-PASS handoff is

What is I-PASS handoff?

I-PASS is a five-part mnemonic for structured handoffs: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver. AHRQ’s TeamSTEPPS curriculum lists it as a communication tool and says it “has become the preferred handoff tool for patient transitions in many organizations” and is “an example of an evidence-based option for conducting a structured handoff” (AHRQ, page last reviewed July 2023).

What is a handoff procedure?

AHRQ’s PSNet defines a handoff as “the process of one healthcare provider updating another of the status of one or more patients for the purpose of handing over responsibility for their care”, for example a physician at change of shift, a nurse moving a patient between departments, or emergency medical services handing a patient to the emergency department. A handoff procedure is the organisation’s agreed routine for doing that. AHRQ says a facility “should determine a standard protocol for delivering handoffs and make it known to everyone”. PSNet adds that Joint Commission standard PC.02.02.01 requires an opportunity for discussion between giver and receiver, and that the Joint Commission does not recommend a specific tool, so I-PASS is one way to meet the requirement, not the requirement itself (PSNet, last reviewed 2024).

Who runs it and what it covers

The mnemonic is described openly on AHRQ’s TeamSTEPPS page. Its main evidence base comes from the I-PASS Study Group, whose 2014 multicenter study covered nine hospitals and was funded by the Office of the Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services and others. A separate company, the I-PASS Patient Safety Institute, offers training and implementation support. Its own site lists tailored trainings, implementation plans and coaching, and says its written handoff tool can be optimized within an existing electronic health record. A 2023 study’s conflict statement describes the Institute as “a company that seeks to train institutions in best handoff practices and aid in their implementation” and discloses that several of that paper’s authors hold equity or stock options in it or have consulted for it.

Studied settings include resident handoffs in nine hospitals (2014), residents across 32 hospitals (2023), an orthopaedic surgery version and an emergency department adaptation. PSNet also reports improved quality of nursing handoffs, effectiveness in cancer care and pediatric emergency care, and an adaptation that includes patients and families.

How to use I-PASS: the five elements

PSNet notes that effective handoffs need an environment free of interruptions and distractions so the receiver can listen and discuss. Within that setting, AHRQ lists the content of each step:

1. Illness severity. A one-word label: stable, “watcher”, or unstable.
2. Patient summary. A summary statement, events leading up to admission or the care transition, the hospital course or treatment plan, ongoing assessment, and the contingency plan.
3. Action list. A to-do list with timelines and ownership.
4. Situation awareness and contingency planning. Know what is going on and plan for what might happen. PSNet describes this as directions in case of changes, often in an “if–then” format.
5. Synthesis by receiver. The receiver summarizes what was heard, asks questions and restates the key actions or to-do items.

There is no single mandated form. Organisations turn these prompts into a verbal script, a printed sheet or an electronic health record template of their own.

Can you provide an example of an I-PASS handoff?

Illustrative composite: an invented example to show the structure, not a real patient and not clinical guidance.

• Illness severity: “Watcher.”
• Patient summary: “Mr. A, admitted two days ago with pneumonia. Improving since admission. Lives alone; his daughter has been updated.”
• Action list: “Follow up this morning’s blood results — day-team resident, by midday. Confirm the physiotherapy review is booked — day nurse.”
• Situation awareness and contingency: “If he looks worse, call the covering physician. If the results come back abnormal, discuss with the senior doctor before changing the plan.”
• Synthesis by receiver: “Watcher, pneumonia improving. I’ll chase the blood results by midday and book physio. If he looks worse I’ll call the covering physician. Has the daughter been told about discharge planning?”

The last line shows the point of the final element: the receiver says it back and asks a question, so gaps surface before the sender leaves.

Strengths and limits

What the evidence shows

• 2014, nine hospitals. Across 10,740 patient admissions, the medical-error rate fell 23% (24.5 to 18.8 per 100 admissions) and preventable adverse events fell 30% (4.7 to 3.3 per 100). Nonpreventable adverse events did not change significantly (3.0 and 2.8 per 100). Reductions in errors were significant at six of the nine sites. Oral handoffs took 2.4 minutes per patient before and 2.5 after, a difference that was not significant (Starmer et al., New England Journal of Medicine).
• 2023, 32 hospitals. With 18 months of external coaching, resident-reported major handoff-related adverse events fell from 1.7 to 0.9 per person-year and minor events from 17.5 to 9.3. Inclusion of all five key elements rose from 20% to 66% of verbal handoffs and from 10% to 74% of written ones, and verbal receiver synthesis rose from 31% to 83% (Starmer et al., Journal of Hospital Medicine).

Limits

• It was a program, not only a mnemonic. The 2014 intervention combined the mnemonic with handoff and communication training, a faculty development and observation program, and a sustainability campaign. The 2023 study added external coaching and monthly metric reviews. Adopting the acronym alone is not what those studies tested.
• Better handoffs did not always change outcomes. In an orthopaedic surgery version, 8 of 9 targeted quality elements improved across 705 handoffs and 86% of providers supported ongoing use, yet there were no statistically significant differences in measured clinical outcomes such as readmission or surgical site infection (Stenquist et al.).
• Adaptation is still being worked out. In an emergency department needs assessment, focus groups agreed the patient summary should include the anticipated disposition, and the authors called for implementation and outcome research (Heilman et al.).

Alternatives: SBAR and other handoff formats

What is the difference between SBAR and I-PASS?

SBAR has four parts (Situation, Background, Assessment, Recommendation). I-PASS has five and, unlike SBAR, builds in an illness severity label, an action list with ownership, contingency planning and a receiver read-back. PSNet lists both as structured handoff tools. For a comparison of when each fits, with worked scripts, see CASRAI’s guide to SBAR handoff communication.

Format	Structure	What the cited sources say
I-PASS	Illness severity; Patient summary; Action list; Situation awareness and contingency planning; Synthesis by receiver	PSNet: “considered the gold standard for effective signout communication between physicians”; two multi-site studies above.
SBAR	Situation; Background; Assessment; Recommendation	PSNet: “Results are mixed on the effectiveness of SBAR in improving transfer of information”; a systematic review found outcomes improved when it was bundled with other safety interventions.
ANTICipate, SHARQ	Other acronyms	AHRQ notes that some healthcare organizations developed them to support effective handoffs.

Related reading on the same patient-safety theme: rapid response team activation criteria, critical value reporting and read-back, safety huddle structure, high reliability organization principles and the National Patient Safety Goals.

FAQ

What is I-PASS handoff?

A five-part structured handoff format: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver. AHRQ’s TeamSTEPPS curriculum describes it as an evidence-based option for structured handoffs.

Can you provide an example of an I-PASS handoff?

Yes: the illustrative script above walks through all five elements, ending with the receiver’s read-back.

What is the difference between SBAR and I-PASS?

SBAR is four parts (Situation, Background, Assessment, Recommendation); I-PASS is five and adds an illness severity label, an action list with ownership, contingency planning and receiver synthesis. See the comparison table above and the SBAR guide.

What is a handoff procedure?

The agreed routine by which one clinician updates another on a patient’s status when handing over responsibility for care. The Joint Commission requires an opportunity for discussion between giver and receiver but does not recommend a specific tool.

Sources

• AHRQ TeamSTEPPS, “Tool: I-PASS”, last reviewed July 2023 (as of 2026-11-07): ahrq.gov/teamstepps-program/curriculum/communication/tools/ipass.html
• AHRQ PSNet, “Handoffs and Signouts”, last reviewed 2024 (as of 2026-11-07): psnet.ahrq.gov/primer/handoffs-and-signouts
• Starmer AJ et al. “Changes in medical errors after implementation of a handoff program.” N Engl J Med 2014;371(19):1803-12. PMID 25372088, doi:10.1056/NEJMsa1405556 (as of 2026-11-07)
• Starmer AJ et al. “Implementation of the I-PASS handoff program in diverse clinical environments.” J Hosp Med 2023;18(1):5-14. PMID 36326255, doi:10.1002/jhm.12979 (as of 2026-11-07)
• Stenquist DS et al. “Sustained improvement in quality of patient handoffs after orthopaedic surgery I-PASS intervention.” J Am Acad Orthop Surg Glob Res Rev 2022;6(9):e22.00079. PMID 36067218 (as of 2026-11-07)
• Heilman JA et al. “Adapting the I-PASS handoff program for emergency department inter-shift handoffs.” West J Emerg Med 2016;17(6):756-761. PMID 27833685 (as of 2026-11-07)
• I-PASS Patient Safety Institute, home page (as of 2026-11-07): ipassinstitute.com