Background:
The exchange of clinical information and patient care responsibility between physicians is crucial in the care of hospitalized patients. Many studies have looked at sign‐out/handoffs involving residents and interns and elicited mixed opinions. Very few studies have looked at sign‐outs between hospitalist attendings. Our purpose is to describe a group‐based e‐mail communication/sign‐out system that can provide uninterrupted flow of information among all caregivers.
Description:
Our hospitalist group has an Internet/e‐mail sign out system. We have created a secure e‐mail distribution list that includes all the hospitalists. At the end of each shift, the outgoing physician updates all information and sends it to the distribution list, that is, all the hospitalists receive the same sign‐out on all patients at the same time. Verbal sign‐out is only given to the incoming hospitalist. We conducted a questionnaire survey of our group of 8 hospitalists about this type of communication system.
Discussion:
This type of communication system carries various advantages, the greatest of which is that all the hospitalists are able to follow patient care “virtually,” even when they are off. It is not uncommon to see multiple hospitalists take care of the same patients simultaneously. Given hospitalists' schedules (a week on, a week off or a similar system in which a quarter or half of the hospitalists are off at any given time), we believe it is crucial that they be in touch with patient care (at least peripherally) in order to have an easy transition when they come on duty. As the incoming hospitalist also knows what is going on, verbal sign‐out becomes dynamic, interactive, bidirectional, and, consequently, very effective. Any communication between any physicians about any patient is known to the entire group. We found that this approach helps immensely to bridge multiple potential communication gaps. Our survey suggests that this type of communication is superior to traditional models and certainly a step forward toward fulfilling Joint Commission on Accreditation of Healthcare Organizations expectations about the communication and smooth transition aspects of the national patient safety goals. Disadvantages include that not all nonhospitalist physicians use e‐mail as a primary mode of communication. Given the confidentiality of patient data and HIPAA guidelines, we recommend using only highly secured e‐mail systems. We are planning on doing a more extensive survey involving multiple sites but within the same hospitalist group and also on assessing the satisfaction of primary care physicians, consultants, and ancillary staff with this type of communication.
Conclusions:
All the hospitalists (100%) preferred the e‐mail distribution list sign‐out system over other types. All used sign‐outs as the predominant way of keeping up with the clinical progress of their patients when off duty, and 90% also used a limited electronic medical record (EMR) that includes laboratory data and certain radiologic and procedural reports to follow their patients' progress. All thought that it eases transition and handoff among hospitalists and conveys a philosophy among hospitalists and consultants that there is collaborative approach to patient care. Ninety percent of the responders also thought that this type of sign‐out helps them to know patients better and be better physicians. Eighty percent of our hospitalists suggested that the format be standardized to improve the quality of the information conveyed on individual patients. Ten percent of the hospitalists expressed concern about the security and confidentiality of this type of sign‐out. All (100%) were satisfied with this type of sign‐out and would advise this system to others.
Author Disclosure:
V. B. Gandla, None; M. Krivopal, None.