It’s 6:45 p.m., and the day resident has 12 patients to sign out in 15 minutes. The patient who needs the most attention gets the same 30 seconds as the stable ones, and the plan for what to do if her blood pressure drops stays in the outgoing resident’s head.
That’s the problem that I-PASS® was created to fix.
I-PASS is a structured handoff format that gives every handoff the same five parts, starting with the patient’s current condition. This guide covers what each letter means, an example you can adapt, how I-PASS differs from SBAR, and a free Snippet that keeps the structure when sign-out is rushed.
Key takeaways
- I-PASS stands for Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver. AHRQ’s TeamSTEPPS program includes it as a structured handoff tool.
- An I-PASS handoff starts with how sick the patient is. Labeling each patient stable, “watcher,” or unstable tells the receiver where to look first.
- I-PASS is built for handoffs, and SBAR works for any report that needs action. Many units use SBAR to call a provider and I-PASS for shift change.
- The written part fits a Snippet, and the last step stays spoken. Fill-ins prompt for each part, and the receiver still summarizes out loud.
What is the I-PASS handoff process?
An I-PASS handoff is a structured communication format for patient handoffs, when responsibility for a patient passes from one clinician to the next. I-PASS stands for Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver, and every handoff covers all five parts in the same order.
Residents and hospitalists use the I-PASS handoff at sign-out, and many nursing units use it for shift report, bedside handoffs, and transfers. AHRQ’s TeamSTEPPS program says I-PASS “has become the preferred handoff tool for patient transitions in many organizations” and calls it “an example of an evidence-based option for conducting a structured handoff.”
I-PASS was developed by Boston Children’s Hospital pediatricians Christopher Landrigan, MD, MPH, and Amy Starmer, MD, MPH, and tested by a multicenter team of clinicians.
A 2014 study in the New England Journal of Medicine by Starmer and colleagues, titled “Changes in Medical Errors after Implementation of a Handoff Program,” describes the program across nine pediatric residency programs that combined the I-PASS mnemonic for oral and written sign-outs with formal training and faculty development.
Later research expanded the program to 32 diverse hospitals, including adult, pediatric, academic, and community hospitals.
Today, the I-PASS Institute offers training for hospitals that want to adopt it.
I-PASS® is a registered trademark of the I-PASS Patient Safety Institute. TextExpander is not affiliated with the I-PASS Institute.
The 5 parts of an I-PASS handoff
AHRQ’s TeamSTEPPS program (Team Strategies and Tools to Enhance Performance and Patient Safety) breaks each part of the I-PASS handoff into a few prompts. Each part also has one slip that tends to weaken it on a busy shift.
I: Illness severity
Say whether the patient is stable, a “watcher,” or unstable before anything else. That one word tells the receiver which patients need attention first.
A common slip is calling every patient “stable” out of habit.
P: Patient summary
Give a summary statement, the events leading up to admission or the care transition, the hospital course or treatment plan, the ongoing assessment, and the contingency plan. Keep it short enough for the receiver to hold onto.
A common slip is giving the history without the current assessment, so the receiver knows how the patient got here but not how they’re doing now.
A: Action list
List the to-dos, each with a timeline and an owner. AHRQ’s wording is a “to-do list” with “timelines and ownership.”
A common slip is “follow up on the labs” with no one named and no time attached, so the task falls between shifts.
S: Situation awareness and contingency planning
Share what’s going on and plan for what might happen. The easiest format is if/then, as in “if this happens, then do that.”
A common slip is a plan that lives only in the outgoing clinician’s head.
S: Synthesis by receiver
The receiver summarizes what they heard, asks questions, and restates the key actions. This step closes the loop.
A common slip is a quick “Got it” in place of a real summary.
The two S’s in the I-PASS mnemonic are easy to blur together. Situation awareness belongs to the person giving the handoff, and synthesis belongs to the person receiving it.
I-PASS handoff example
This example uses sentence starters in place of a real patient, so you can see the shape of an I-PASS handoff without any clinical details. Fill in your own patient care details and follow your unit’s standards for what goes in each part.
Giving the handoff: “Room {Room} is a watcher. {One-line summary statement}. They came in for {Reason for admission}, and the plan is {Treatment plan}. Right now, {Ongoing assessment}. Two things to do: {Task 1}, which you own, by {Time}, and {Task 2}, which {Owner} owns, by {Time}. If {What might happen}, then {What to do}.”
Receiving it: “So Room {Room} is a watcher. I’ll {Task 1} by {Time}, {Owner} has {Task 2}, and if {What might happen}, I’ll {What to do}. One question: {Open question}?”
Notice what the example does. Severity comes first, every action has an owner and a time, the if/then plan is said out loud, and the receiver repeats it back in their own words.
For nursing handoffs at shift report, the same five parts work at the bedside. The outgoing nurse leads with severity, covers the summary and pending tasks, and names the if/then plan, and the oncoming nurse summarizes before the outgoing nurse leaves. Follow your unit’s handoff standard for what goes in each part.
It definitely makes me able to work more efficiently, so I am able to complete more reports during my shift.
Jessica L., G2 review
I-PASS vs SBAR: what’s the difference?
I-PASS is built for handoffs, when responsibility for a patient moves from one clinician to another. SBAR is a general format for any report that requires someone to act, such as a call to a provider about a change in condition.
I-PASS adds an illness severity label, an owned action list, an explicit contingency plan, and a required summary from the receiver.
| I-PASS | SBAR | |
|---|---|---|
| Built for | Shift-change handoffs and sign-out | Any report that needs someone to act, including calls to a provider |
| First thing said | Illness severity | The situation |
| Actions | An owned to-do list with times | One recommendation |
| Contingency | An explicit if/then plan | Not a separate step |
| Receiver’s role | Synthesis by receiver is a required step | Read-back of any orders |
| Typical users | Residents, hospitalists, and nursing units | Nurses and other clinicians |
Many units use both, with SBAR for calls to a provider and I-PASS for shift change. Follow your organization’s standard. For the SBAR side, see our guide to SBAR nursing handoffs.
Why handoff communication slips at shift change
In its Sentinel Event Alert on hand-off communication, the Joint Commission lists lack of time, interruptions or distractions, and a lack of standardized procedures among the factors behind failed handoffs and the communication failures that come with them.
Handoffs occur frequently, at every shift change, transfer, and break, so the same gaps repeat all day. At sign-out, critical information is often lost through three gaps in handoff communication, each corresponding to a part of I-PASS.
- Severity goes unstated. Every patient gets the same airtime, so the one who needs attention doesn’t stand out.
- Actions have no owner. “Someone should check that” turns into no one checking it.
- The contingency stays unspoken. The outgoing clinician knows what to do if things change, and the receiver has to work it out on their own.
How hospitals implement the I-PASS handoff program
Hospitals that adopt I-PASS usually treat I-PASS implementation as a full program, with I-PASS handoff training, observation, and feedback.
The I-PASS Patient Safety Institute’s program includes a virtual training platform where clinicians practice “giving and receiving written and verbal I-PASS structured handoffs,” direct observation tools for “monitoring handoffs and gaining insights into I-PASS adherence in real time,” and “an electronic platform that integrates with any EHR to facilitate the written handoff process.”
Clinical champions observe live verbal handoffs and provide feedback, enabling hospitals to track handoff compliance. Those handoff audits show where the I-PASS handoff tool is working and where teams need more coaching.
Nursing departments go through the same process. In a 2025 quality improvement report in BMJ Open Quality, The University of Texas MD Anderson Cancer Center described how, before its rollout, “the nursing handoff structure varied from one department to another,” with SBAR as “the dominant handoff framework.”
In 2020, the board identified handoffs as an area of improvement, and the chief nursing officer sponsored the project. A nursing handoff leadership team began with two onsite handoff observations with frontline staff and five virtual sessions to identify the barriers hindering effective handoffs. The authors point to time pressures, inadequate training, inconsistent handoff procedures, and interruptions as reasons that make patient handoffs challenging.
The project set out to standardize handoff procedures and “educate all nurses on using I-PASS in all nursing areas.” The team chose I-PASS “as a validated handoff tool” and developed an I-PASS handoff workflow in its EHR with frontline staff and unit leaders, including two EHR handoff report formats: a temporary handoff report for patients going to a procedural area and a permanent handoff report for shift change and permanent transfers. It also ran “25 one-on-one train-the-trainer sessions (45 min each) for all nurse leaders.”
By November 28, 2022, all nurses had been trained, and the I-PASS handoff report was live in the EHR. The team then tracked adherence: I-PASS elements were present in more than 95% of observed verbal handoffs from April 2023 to April 2024, and compliance in documenting I-PASS handoffs ran between 86% and 88% from December 2022 to April 2024.
A Snippet supports that work by putting the same five parts of the I-PASS methodology in front of every clinician at every sign-out, within the tools they already use.
How to make the I-PASS handoff procedures a habit
Knowing I-PASS and using all five parts on a busy Tuesday at 6:45 p.m. are two different skills. The second one takes a habit, and habits rest on a cue, a structure that’s easy to follow, and repetition.
- Cue: a specific trigger, like “When I start sign-out, I type ;handoff.” In a meta-analysis of 94 independent tests, Gollwitzer and Sheeran found that if-then plans like this one had a positive effect on goal attainment of “medium-to-large magnitude (d = .65).”
- Structure: the Snippet lays out all five parts with prompts, so the order is never in question.
- Repetition: every sign-out is another repetition. In a study of real-world habit formation, Lally and colleagues found a median of 66 days for a new daily behavior to become automatic, and missing one opportunity “did not materially affect the habit formation process.”
Your abbreviation is your cue, and the Snippet carries the five parts of I-PASS. This post is part of a series on building work habits with Snippets, and you can read how customers made their first Snippet stick in how TextExpander customers went from their first Snippet to a daily habit.
The standard of practice is smoother since we have set messages, and charting goes by faster.
Julie N., G2 review
The I-PASS-inspired shift handoff Snippet (copy it free)
This Snippet follows the I-PASS handoff structure for patient handoffs. It isn’t official I-PASS material, and for training, see the I-PASS Institute.
It uses Fill-ins for every part that changes. A word in {braces} is a field you type into, options separated by a slash are a pop-up menu you pick from, and lines in [square brackets] are optional sections you include only when you need them. The date and time at the top are filled in automatically.
Shift handoff, {Today’s date and time}
Illness severity: {Stable / Watcher / Unstable}
Patient summary: {Room/bed}. {Summary statement}. Events leading to admission: {Events}. Course and plan: {Hospital course or treatment plan}. Ongoing assessment: {Ongoing assessment}.
Action list: {Task 1} (owner: {Owner}, by {Time}).
[Second action: {Task 2} (owner: {Owner}, by {Time}).]
[Contingency: if {What might happen}, then {What to do}.]
Synthesis by receiver: {Receiver summarized and restated actions / Receiver has open questions}
I love the ability to customize with drop-downs, optional selections and automatic date calculations.
Hayley M., physician
Keep patient information out of the Snippet
The Snippet holds only the structure of the handoff. Never store protected health information (PHI) in the Snippet itself. Patient-specific details appear only in the Fill-in fields when you expand the Snippet.
TextExpander’s HIPAA page says Snippets “should not contain any patient personal health information (PHI),” and TextExpander enters into Business Associate Agreements only for qualified Enterprise plans. Within your EHR or messaging system, follow your organization’s policies on where information goes.
How to set up the Snippet
- Create a new Snippet. Name it Shift handoff and give it the abbreviation ;handoff.
- Paste the readable version. Copy the Snippet text and paste it into the content field.
- Turn each field into a Fill-in. Replace each {brace} with a single-line or multi-line Fill-in from the Fill-ins menu, and give each one a clear name, like Room/bed or Summary statement.
- Add the pop-up menus. Turn the two choice lists (illness severity and synthesis) into pop-up menus, with Stable and “Receiver summarized and restated actions” as the defaults.
- Add the optional sections and the date. Make the second action and the contingency line optional sections, and replace {Today’s date and time} with the date and time from the Date menu.
- Test it once. Type ;handoff in a blank document, fill in made-up details, and check that every field appears in the order you expect.
For watcher and unstable patients, make a second Snippet, ;handoffw, with the contingency section turned on by default.
Add the shift handoff Snippet free
Save the five-part structure once, then type ;handoff at every sign-out. Fill-ins prompt you for severity, owners, and the if/then plan.
Start with your next sign-out.
Make the whole unit hand off the same way
A shared Snippet Group gives every resident or nurse on the service the same handoff process. When the chief resident, charge nurse, or educator updates the wording, the change reaches everyone the next time they use it. That keeps handoff communication consistent from one shift to the next. See how shared Snippets work in TextExpander for business.
When it comes to quality, consistency is key. If you don’t have consistency, you’re not going to have quality.
Amanda Chapman, MBA, MMS, PA-C, Clinical Director, Private Health Management
The same Snippet works in secure messaging, a portal, or a note to the oncoming team. For patient care documentation inside the EHR, follow your organization’s rules and use its native tools, like SmartPhrases. Our guide to SmartPhrase vs SmartText explains the difference, and you can learn more about TextExpander for healthcare teams.
TextExpander helps get everybody on the same page. We’re all working from the same standards, which makes a big difference when you’re scaling.
Julia Ball, Director of Primary Care Services, Amaze Health
Give the I-PASS handoff out loud, too
The written handoff prepares the conversation, and verbal handoffs are where synthesis by the receiver happens, in person or by phone.
The Joint Commission advises clinicians in the same patient safety alert to “avoid making hand-offs using solely electronic or paper communications.” When you can, hand off in a distraction-free environment, leave time for questions, and follow your organization’s handoff policy.
Verbal handoffs are also where the receiver can ask about critical information the written note left out.
Five parts, every sign-out
Back to 6:45 p.m. The day resident types ;handoff for each patient, and every I-PASS handoff follows the same order.
Severity comes first, every action has an owner and a time, the if/then plan gets said out loud, and the night resident summarizes before anyone leaves.
The patient who needs the most attention gets it, because the handoff says so first.
Try TextExpander free and add the shift handoff Snippet to your next I-PASS handoff. For calls to a provider, pair it with the SBAR handoff Snippet, and see how other customers turned their first Snippets into a daily habit.
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Frequently asked questions
What does I-PASS stand for?
I-PASS stands for Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver. AHRQ's TeamSTEPPS program lists it as a structured handoff tool and describes it as "an example of an evidence-based option for conducting a structured handoff."
What is the difference between SBAR and I-PASS?
SBAR is a general format for any report that requires action, and I-PASS is designed for handoffs when patient responsibility changes. I-PASS adds an illness severity label, an owned action list, a contingency plan, and a required summary from the receiver. Many units use SBAR for calls to providers and I-PASS for shift change, and our SBAR handoff guide covers the SBAR side.
What does "watcher" mean in I-PASS?
A watcher is a patient who isn't unstable but needs closer attention than a stable patient. Labeling a patient a watcher tells the receiver to check on them sooner and keep the contingency plan close. Your unit may define the categories more specifically, so follow its standard.
Is I-PASS used in nursing?
Yes. Many nursing units use I-PASS for nursing handoffs at shift report and bedside handoff, and the five parts work the same way, with the oncoming nurse's summary as the synthesis step. Units often adapt the format to their nursing handoff process, so follow your organization's handoff standard.
How can nurse educators use I-PASS to improve nursing handoffs?
Start by teaching I-PASS as the unit's nursing handoff framework, with practice in both delivering handoffs and receiving them. Have nurses rehearse conducting handoff reports with the five parts in order, and talk through what makes appropriate handoff reports for shift change versus a transfer.
Then conduct handoff observations on the unit and give feedback on handoff tasks, like whether each action has an owner and a time. If your unit wants a formal measure, the BMJ Open Quality authors note that other research has developed scales to assess nursing handoff competencies. For bedside report, decide as a unit how much patient involvement you want.
A shared Snippet gives every nurse the same structure to practice with, which makes it easier to see where your unit still needs improved handoff communication.
Can I use an I-PASS template in TextExpander?
Yes. You can save a Snippet that follows the I-PASS handoff structure, like the shift handoff Snippet in this guide, and use Fill-ins for the details that change. Keep patient details in the Fill-ins only, at the moment of use. The Snippet isn't official I-PASS material, and the I-PASS Institute offers training.
Who created I-PASS?
I-PASS was developed by Boston Children's Hospital pediatricians Christopher Landrigan, MD, MPH, and Amy Starmer, MD, MPH, and tested by a multicenter team of clinicians. A 2014 study in the New England Journal of Medicine by Starmer and colleagues describes the handoff program across nine pediatric residency programs. Today, the I-PASS Patient Safety Institute supports hospitals that adopt it.
How does the I-PASS handoff relate to patient safety?
Handoffs happen at every level of the health care system, and breakdowns can compromise patient safety. The BMJ Open Quality authors note that earlier studies found "ineffective handoffs contributed to patient harm," and their project aimed to address "the communication gaps significantly contributing to medical errors during patient handoffs."
That's why many hospitals add structured handoff protocols to their patient safety initiatives. Your quality and patient safety team decides how to enhance patient safety on your unit and which patient safety outcomes to track. A Snippet can support patient safety initiatives by keeping the five parts of I-PASS in front of every clinician, but it doesn't measure patient outcomes, and it can't promise better patient outcomes on its own.
