Consequences of Inadequate Sign-Out for Patient Care

Poor and inconsistent procedures to transfer responsibility for patient care during hospital shift changes lead to adverse consequences for patients, do not provide doctors with critical information, and waste time and resources, according to the first prospective study on this topic.

Transfers of responsibility, or “sign-outs,” have increased with the advent of work-hour restrictions in hospitals. Although retrospective reporting has linked sign-outs to adverse events, the authors believe this study is the first to prospectively study transfers and then follow up on outcomes. Study investigators gave interns audiocassette recorders to record sign-out sessions, collected written sign-out materials and interviewed interns each morning regarding overnight care and events. The study was limited to internal medicine house staff at a single hospital, encompassing 503 individual patient sign-outs, and looking only at events within 12 hours of sign-out.

Key Findings:

  • Sign-out related problems caused adverse events 7.5 times per 100 patient-care days.
  • The most frequent problems involved the omission of information requiring synthesis and judgment, such as: the patient’s current clinical condition; recent and scheduled events; guidance for likely overnight events; follow-up assignments; and how or why to complete a task.
  • Adverse consequences included substantial delays in care, inefficiencies, duplication of effort and occasional patient harm.

The study confirms the link between inadequate communication at sign-outs and adverse events experienced several hours later by patients. The authors call for the standardization of sign-out procedures, focusing on ways to convey an overall picture of the patient and assist in decision-making. The authors also call for research into factors that may affect sign-out quality and the impact of sign-outs on longer-term outcomes.