I-PASS Training Pre / Post Survey

If you selected "Other" above, please indicate the appropriate provider type here.
Please indicate whether you are taking this survey before or after completing the online I-PASS Training modules.(Required)

Less than 15 minutes16 - 30 minutes31 - 45 minutes>45 minutes
NeverRarelySometimesUsuallyAlways
When you are GIVING handoff, about how often do you include all relevant information about the patients you are handing off during shift report?
When you are RECEIVING handoff, about how often does the verbal handoff include all relevant information about the patients you will be caring for on the next shift?
In general, after handoff, how often do you feel ready to care for your patients?

Please refer to the these definitions when responding to the below questions: I. Illness Severity: Identification as stable, "watcher", or unstable; must occur at the beginning of each patient handoff. P. Patient Summary: Might include summary statement, events leading up to admission, hospital course, ongoing assessment, plan. A. Action list: To do list; (must be separated from patient summary). S. Situation Awareness/Contingency Planning: Know what’s going on; plan for what might happen. S. Synthesis by Receiver: Verbal readback to summarize what was heard during verbal handoff.
NeverRarelySometimesUsuallyAlways
Illness Severity
Patient Summary
Action List
Situational Awareness / Contingency Planning
Synthesis (You Synthesize)
NeverRarelySometimesUsuallyAlways
Illness Severity
Patient Summary
Action List
Situational Awareness / Contingency Planning
Synthesis (Receiver Synthesizes)
Would you like the opportunity to receive feedback on your handoff structure?(Required)

Please refer to the below definitions when responding to the below questions: Major Harm: Significant clinical consequences, such as deterioration in clinical status, organ dysfunction, prolonged hospitalization, disability beyond discharge, or death. A problematic handoff would include examples such as: information that was clinically important was not given to you, or you received inaccurate information.
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Over the past 30 days, please estimate the number of your patients who experienced a MINOR harms as a result of a problematic handoff.
Over the past 30 days, please estimate the number of your patients who experienced a MAJOR harms as a result of a problematic handoff.
Please enter a number from 0 to 30.