@article{8088,
  author = {L. I. Horwitz and T. Moin and H. M. Krumholz and L. Wang and E. H. Bradley},
  title = {What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff.},
  abstract = {<p><b>OBJECTIVES: </b>To characterise and assess sign-out practices among internal medicine house staff, and to identify contributing factors to sign-out quality.</p><p><b>DESIGN: </b>Prospective audiotape study.</p><p><b>SETTING: </b>Medical wards of an acute teaching hospital.</p><p><b>PARTICIPANTS: </b>Eight internal medicine house staff teams.</p><p><b>MEASUREMENTS: </b>Quantitative and qualitative assessments of sign-out content, clarity of language, environment, and factors affecting quality and comprehensiveness of oral sign-out.</p><p><b>RESULTS: </b>Sign-out sessions (n = 88) contained 503 patient sign-outs. Complete written sign-outs accompanying 50/88 sign-out sessions (57%) were collected. The median duration of sign-out was 35 s (IQR 19-62) per patient. The combined oral and written sign-outs described clinical condition, hospital course and whether or not there was a task to be completed for 184/298 (62%) of patients. The least commonly conveyed was the patient's current clinical condition, described in 249/503 (50%) of oral sign-outs and 117/306 (38%) of written sign-outs. Most patient sign-outs (298/503, 59%) included no questions from the sign-out recipient (median 0, IQR 0-1). Five factors were associated with a higher rate of oral content inclusion: familiarity with the patient, sense of responsibility for the patient, only one sign-out per day, presence of a senior resident and a comprehensive written sign-out. Omissions and mischaracterisations of data were present in 22% of sign-outs repeated in a single day.</p><p><b>CONCLUSIONS: </b>Sign-outs are not uniformly comprehensive and include few questions. The findings suggest that several changes may be required to improve sign-out quality, including standardising key content, minimising sign-outs that do not involve the primary team, templating written sign-outs, emphasising the role of sign-out in maintaining patient safety and fostering a sense of direct responsibility for patients among covering staff.</p>},
  year = {2009},
  journal = {Qual Saf Health Care},
  volume = {18},
  pages = {248-55},
  month = {08/2009},
  issn = {1475-3901},
  doi = {10.1136/qshc.2008.028654},
  language = {eng},
}