An Assessment of Patient Sign-Outs Conducted by University at Buffalo Internal Medicine Residents

Abstract

Internal medicine residents were surveyed regarding patient sign-outs at shift change. Data were used to design and implement interventions aimed at improving sign-out quality. This quasi-experimental project incorporated the Plan, Do, Study, Act methodology. Residents completed an anonymous electronic survey regarding experiences during sign-outs. Survey questions assessed structure, process, and outcome of sign-outs. Analysis of qualitative and quantitative data was performed; interventions were implemented based on survey findings. A total of 120 surveys (89% response) and 115 surveys (83% response) were completed by residents of 4 postgraduate years in response to the first (2008) and second (2009) survey requests, respectively. Approximately 79% of the respondents to the second survey indicated that postintervention sign-out systems were superior to preintervention systems. Results indicated improvement in specific areas of structure, process, and outcome. Survey-based modifications to existing sign-out systems effected measurable quality improvement in structure, process, and outcome.

Keywords

sign-outs quality improvement handoff communication internal medicine residents

Get full access to this article

View all access options for this article.

References

Joint Commission on Accreditation of Healthcare Organizations. Facts about the National Patient Safety Goals. http://www.jointcommission.org/assets/1/18/National_Patient_Safety_Goals_12_09.pdf . Published December 2009. Accessed May 3, 2011.

Adamski

. Revealed: 2006 National Patient Safety Goals. Nurs Manage. 2005;36:10.

World Health Organization Collaborating Center for Patient Safety Solutions. Patient Safety Solutions—Preamble 2007. Geneva, Switzerland: World Health Organization; 2007.

Lofgren

Gottlieb

Williams

Rich

. Post-call transfer of resident responsibility: its effects on patient care. J Gen Intern Med. 1990;5:501-505.

Laine

Goldman

Soukup

Hayes

. The impact of a regulation restricting medical house staff working hours on the quality of patient care. JAMA. 1993;296:374-378.

Vidyarthi

Arora

Schnipper

Wall

Wachter

. Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out. J Hosp Med. 2006;1:257-266.

Institute of Medicine. Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. Washington, DC: National Academies Press; 2008.

Horwitz

Krumholz

Green

Huot

. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 2006;166:1173-1177.

Colla

Bracken

Kinney

Weeks

. Measuring patient safety climate: a review of surveys. Qual Saf Health Care. 2005;14:364-366.

10.

Petersen

Brennan

O’Neil

Cook

Lee

. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121:866-872.

11.

Advanced Informatics. E*Value. https://www.e-value.net/ . Accessed June 9, 2010.

12.

US Department of Health and Human Services. Code of Federal Regulations Title 45 Public Welfare, Part 46 Protection of Human Subjects. Washington, DC: US Department of Health and Human Services; 2010.

13.

Joint Commission on Accreditation of Healthcare Organizations. Healthcare at the Crossroads: Strategies for Improving the Medical Liability System and Preventing Patient Injury. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2005.