What are Covering Doctors Told about Their Patients?
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.
- Of the 503 sign-outs, 57 percent had complete written accompaniment. The median length of verbal sign-out was 35 seconds.
- Only half of oral sign-outs and 38 percent of written sign-outs fully conveyed the patient’s current clinical condition.
- Of the sign-outs with both a verbal and written component, 62 percent fully documented the patient’s current clinical condition, course of treatment and future tasks.
- The recipient of the sign-out asked a clarifying question in 41 percent of sign-outs. Disagreements over potential care were very rare, occurring only nine times in 503 hand-offs.
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.