What are Covering Doctors Told about Their Patients?

Analysis of Sign-Out Among Internal Medicine House Staff

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.

Key Findings:

  • 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.