Implementation of the I-PASS Handover Framework in an Internal Medicine Unit at a Sudanese Teaching Hospital: An Exploratory Pre-Post Audit

Purpose: This pre-post implementation audit aimed to evaluate adherence to the I-PASS (illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver) handoff framework before and after an educational intervention in the Internal Medicine Department at Ribat Teaching Hospital. Background: Effective patient handover is critical for continuity and quality of care, and miscommunication during transitions is a major contributor to preventable harm. While structured tools such as I-PASS have improved handoff quality in high‑resource settings, evidence from low‑resource environments, including Sudan, remains limited. Teaching hospitals in Sudan face overcrowding, workforce shortages, and fragmented information systems, which increase the risk of communication errors. Materials and methods: This exploratory quasi-experimental pre-post implementation audit was conducted in one Internal Medicine Unit at Ribat Teaching Hospital, Khartoum, Sudan. All handoffs for inpatients requiring close monitoring during the study period were eligible. Two cycles of observation were completed. In each cycle, adherence to the five I‑PASS elements was recorded using a checklist during live verbal handoffs. Between cycles, a structured educational program on I‑PASS was delivered to unit staff. Data were analyzed descriptively, and Fisher’s exact test was used to compare adherence proportions between cycles. Results: A total of 105 handoffs were observed (55 in cycle one and 50 in cycle two). In cycle one, adherence varied across I‑PASS elements: illness severity 22/55 (40%), patient summary 37/55 (67%), action plan 55/55 (100%), situational awareness 20/55 (36%), and synthesis by receiver 37/55 (67%). After the educational implementation, adherence improved for most elements: illness severity 43/50 (86%; p<0.001), patient summary 44/50 (88%; p=0.019), action plan 50/50 (100%; p=1.000), situational awareness 42/50 (84%; p<0.001), and synthesis by receiver 48/50 (96%; p<0.001). Conclusion: The I‑PASS framework was feasible to implement in a low‑resource internal medicine unit and was associated with improved short‑term adherence to structured handoff elements after targeted education. The study did not measure adverse events or error rates; therefore, no conclusions can be drawn about the impact of I‑PASS on patient safety. Longer‑term, multi‑unit evaluations incorporating safety outcomes and potential confounders are warranted.