title: Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward.
abstract: BACKGROUND
  Prior research on reducing variation in housestaff handoff procedures have depended on proprietary checkout software. Use of low-technology standardization techniques has not been widely studied.
  
  
  OBJECTIVE
  We wished to determine if standardizing the process of intern sign-out using low-technology sign-out tools could reduce perception of errors and missing handoff data.
  
  
  METHODS
  We conducted a pre-post prospective study of a cohort of 34 interns on a general internal medicine ward. Night interns coming off duty and day interns reassuming care were surveyed on their perception of erroneous sign-out data, mistakes made by the night intern overnight, and occurrences unanticipated by sign-out. Trainee satisfaction with the sign-out process was assessed with a 5-point Likert survey.
  
  
  RESULTS
  There were 399 intern surveys performed 8 weeks before and 6 weeks after the introduction of a standardized sign-out form. The response rate was 95% for the night interns and 70% for the interns reassuming care in the morning. After the standardized form was introduced, night interns were significantly (p < .003) less likely to detect missing sign-out data including missing important diseases, contingency plans, or medications. Standardized sign-out did not significantly alter the frequency of dropped tasks or missed lab and X-ray data as perceived by the night intern. However, the day teams thought there were significantly less perceived errors on the part of the night intern (p = .001) after introduction of the standardized sign-out sheet. There was no difference in mean Likert scores of resident satisfaction with sign-out before and after the intervention.
  
  
  CONCLUSIONS
  Standardized written sign-out sheets significantly improve the completeness and effectiveness of handoffs between night and day interns. Further research is needed to determine if these process improvements are related to better patient outcomes.
authors.affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA. stephen.salerno@us.army.mil
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Salerno
authors.forename: Michael V
authors.initials: MV
authors.lastname: Arnett
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Domanski