Methemoglobinemia as a complication of topical dapsone.

n engl j med 372;5 nejm.org january 29, 2015 491 tion techniques used by high-reliability organizations, the I-PASS mnemonic offers a predictable structure that enhances the process of information transfer.1,2 However, we hypothesized that to effect significant, sustainable change, we needed to change institutional handoff culture substantively at the same time that we introduced the mnemonic. Therefore, in addition to the mnemonic, our I-PASS Handoff Bundle included a multifaceted training program, changes to verbal handoffs, a handoff tool based on the electronic medical record to reinforce the mnemonic, and a faculty development and cultural change program.3,4 Collaborative cross-checking5 or the inclusion of questions by the receiving team that challenge the team handing off the patient regarding the treatment of the patient is a concept inherent in the final I-PASS mnemonic element of synthesis by receiver. We agree that this technique was an important part of the success of the I-PASS Handoff Bundle. Amy J. Starmer, M.D., M.P.H. Christopher P. Landrigan, M.D., M.P.H.