This article analyzes the interactions between medical staff at an acute care teaching hospital as they transfer care of patients. Poor quality sign-outs of patients can result in harm and are a significant contributor to malpractice claims against internal medicine physicians. However, most hospitals, including the academic hospital in this study, do not have sign-out protocols and do not offer training to improve the quality of handoffs.
The authors collected data on 503 individual verbal sign-outs by 24 residents and interns. They also collected written sign-out material for 287 encounters. The sign-outs were analyzed for content, comprehensiveness, clarity of language and external environment noise.
These results indicate that most sign-offs do not consistently convey important information about a patient’s clinical care, condition and future treatment. Since the rate of sign-offs may be increasing as resident hours are shortened, policy-makers should consider how to improve and standardize the sign-off procedure.