Verbal And Electronic Signouts May Improve Patient Handoffs

Authors report the results of a before/after study where a face-to-face verbal sign out was implemented along with a change in the electronic sign out template that included cues for appropriate content. The authors found improved resident satisfaction in the handoff process, no change in patient safety events, and improved quality of written signout content based on blinded investigator review. Limitations of this study include its before/after design as it is difficult to attribute the changes in outcomes to the study interventions, and with 2 interventions being implemented, one cannot determine which component was associated with the changes observed. The blinded investigator review of written sign out quality showed high inter-rater reliability (kappa = 0.95) and statistically significant improvements and perfect or near perfect rates of adherence post intervention for many of the areas assessed (documenting past medical history 100%, active problem list and current clinical status both at 96%), but this is largely explained by the change in the template which included those content areas, and therefore the investigator review could not have been truly blinded as the signouts clearly looked different. Nevertheless, the study highlights useful insights into consideration of systems-based issues, such as changes in electronic sign out templates, to capture vital information needed for better communication between residents.— Sarang Kim, MD

Graham, KL, Marcantonio, ER, Huang, GC, Yang, J, Davis RB, Smith, CC. Effect of a systems intervention on the quality and safety of patient handoffs in an internal medicine residency program. J Gen Intern Med. 2013 Aug;28(8): 986-993.

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