title: Template for success: using a resident-designed sign-out template in the handover of patient care.
abstract: OBJECTIVE
  Report our implementation of a standardized handover process in a general surgery residency program.
  
  
  METHODS
  The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System.
  
  
  METHODS
  Nonprofit, tertiary referral teaching hospital.
  
  
  METHODS
  General surgery residents, residency faculty, patient care providers, and hospital administration.
  
  
  RESULTS
  After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents.
  
  
  CONCLUSIONS
  The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures.
authors.affiliation: Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington 98101, USA. clancy.clark@vmmc.org
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Sindell
authors.forename: Richard P
authors.initials: RP
authors.lastname: Koehler
mesh_terms: D017598:Efficiency, Organizational; D005260:Female; D013502:General Surgery / Q000458:organization & administration; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007400:Interprofessional Relations; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer / Q000458:organization & administration*; D015397:Program Evaluation; D058996:Quality Improvement; D017749:Total Quality Management; D014481:United States