Communication problems between hospital house staff are one of the most common causes of preventable medical adverse events. The process of signing out is a critical part of the communication process that takes place between residents. In an attempt to standardize and streamline the hands‐off process and to reduce the number of medical adverse events attributable to inadequate sign‐outs, we introduced an electronic sign‐out system based on a retrievable database format at our institution. The sign‐out system was a low‐cost, concise electronic system for hands‐off communication. The system can but does not necessarily have to be linked to electronic medical records. Information recorded was: demographical data, active and chronic diagnoses, past medical history (PMH), history of present illness (HPI), significant findings, and tasks to follow up on.
Preimplementation and postimplementation surveys were handed out and collected from the attendings and residents in the Department of Medicine. The postimplementation survey was done 4 months after all users were trained on the electronic sign‐out system. Brief training sessions (30 minutes) were conducted during the rollout phase of the sign‐out system.
During the 4‐month period 1800 patients were recorded in the sign‐out system, many of them on multiple occasions. A total of 54 residents and attendings filled out the first survey (83%), and 33 filled out the second (51%). Most (73%) believed they needed less than 10 minutes to enter a new patient into the sign‐out system. Median self‐reported time spent to daily update sign‐out before and after was: 20 minutes (IQR 5‐20 minutes) and 15 minutes (IQR 15‐25 minutes) for weekdays (P=.51) and 5 minutes (IQR 5‐20 minutes) and 15 minutes (IQR 5‐20 minutes), P= .047. Detailed HPI, PMH, and studies to follow up were included in the following proportions (before‐after): 15%‐51% (P < .001), 26%‐57% (P = .006), and 22%‐54% (P < .001), respectively. For problem solving: the sign‐out was not helpful 20% of the time before and 3% of the time after and was always helpful 30% of the time before and 44% of the time after (P = .018). The overall impression of the new system was good (54%) to excellent (46%), and 73% of residents found it to be an educational tool. The system was thereafter adopted by several other departments in our institution .
Implementation and adoption of a department‐wide standardized electronic sign‐out system was accomplished with relative ease over the course of a few months. The perception of most residents and attendings was that it improved both patient safety and quality of care.
Implementation of an electronic sign‐out system was found to be effective (as evident by the number of patients entered in a short period), efficient, and low cost. It improved quality of communication and eased the process of problem solving.
Future goals would be to include outpatients in our system and to make it available to primary care physicians.
S. Gandhi, None; J. Rachoin, None; E. Cerceo, None; E. Jarbirnk‐Seghal, None; V. Rajput, None; E. Kupersmith, sanofi‐aventis, research grants; sanofi‐aventis, consulting fees or other remuneration (payment); Merck, consulting fees or other remuneration (payment); Pfizer, consulting fees or other remuneration (payment).