title: Resident sign-out and patient hand-offs: opportunities for improvement.
abstract: BACKGROUND
  Inpatient care is characterized by multiple transitions of patient care responsibilities. In most residency programs trainees manage transitions via verbal, written, or combined methods of communication termed "sign-out." Often sign-out occurs without standardization or supervision.
  
  
  OBJECTIVE
  The purpose was to assess daily sign-out with a goal of identifying aspects of this process most in need of improvement.
  
  
  METHODS
  This was a prospective, observational cohort study of interns' sign-out conducted by industrial engineering students. Daily sign-out was analyzed for inclusion of multiple criteria and scored on organization (on a scale of 0-4) based on how effectively written information was conveyed.
  
  
  RESULTS
  We observed 124 unique verbal and written sign-outs. We found that 99% of sign-outs included a general hospital course. Sign-outs were well organized with a mean of 3.1, though substantial variation was noted (SD = 0.8). Directions for anticipated patient events were included in only 42% of sign-outs. Do Not Resuscitate (DNR) or advanced directive discussions were reported in only 11% of sign-outs. Only 50% of successive daily sign-outs were updated.
  
  
  CONCLUSIONS
  We found variability in the content and organization of interns' sign-out, possibly reflecting a lack of instruction and supervision. Standardization of sign-out content, and education on good sign-out skills are increasingly important as patient hand-offs become more frequent.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA. bumpgm@upmc.edu
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Bump
authors.forename: Franziska
authors.initials: F
authors.lastname: Jovin
authors.forename: Lindsay
authors.initials: L
authors.lastname: Destefano
authors.forename: Amanda
authors.initials: A
authors.lastname: Kirlin
authors.forename: Andrew
authors.initials: A
authors.lastname: Moul
authors.forename: Kelly
authors.initials: K
authors.lastname: Murray
authors.forename: Deborah
authors.initials: D
authors.lastname: Simak
authors.forename: D Michael
authors.initials: DM
authors.lastname: Elnicki
mesh_terms: D015331:Cohort Studies; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D006801:Humans; D010360:Patient Transfer / Q000458:organization & administration*; D010414:Pennsylvania; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*