Safety of using a computerized rounding and sign-out system to reduce resident duty hours.
OBJECTIVE
To determine whether changing sign-out practices and decreasing the time spent in rounding and recopying patient data affect patient safety. Responding to limited resident duty hours, the University of Washington launched a computerized rounding and sign-out system ("UW Cores"). The system shortened duty hours by facilitating sign-out, decreasing rounding time, and sharply reducing the time spent in prerounds data recopying.


METHODS
This 14-week, randomized, crossover study involved 14 inpatient resident teams (6 general surgery, 8 internal medicine) at two hospitals. The authors measured resident-reported deviations in expected care that occurred during cross-coverage, medical errors, and institutionally reported adverse drug events (ADEs).


RESULTS
The mean number of resident-reported deviations from expected care per 1,000 patient-days did not differ significantly between the control and UW Cores groups: 14.29 and 13.81, respectively (P = .85). The mean number of reported incidents involving errors was 6.33 per 1,000 patient-days for the control group and 5.61 per 1,000 patient-days for the UW Cores group (P = .68). The odds ratio of a reported overnight medical error under the UW Cores system was 1.01 (95% CI: 0.64, 1.60; P = .96). The odds ratio of an ADE while a resident is on an intervention team was 1.10 (95% CI: 0.69, 1.74; P = .70).


CONCLUSIONS
Managing information for sign-out and rounding with the UW Cores system, to reduce time spent in recopying patient data and in rounding on patients, improved continuity and enhanced resident efficiency without weakening systemic defenses against error or jeopardizing patient safety.
Van Eaton
Erik G
EG
University of Washington School of Medicine, Seattle, 98195-6410, USA. vane@u.washington.edu <vane@u.washington.edu>
McDonough
Karen
K
Lober
William B
WB
Johnson
Eric A
EA
Pellegrini
Carlos A
CA
Horvath
Karen D
KD
D003266:Continuity of Patient Care / Q000458:organization & administration*; D018592:Cross-Over Studies; D017598:Efficiency, Organizational; D013502:General Surgery / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration*; D007396:Internship and Residency / Q000458:organization & administration*; D019300:Medical Errors / Q000706:statistics & numerical data; D016017:Odds Ratio; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011787:Quality of Health Care; D014861:Washington; D016526:Workload / Q000592:standards