title: Implementing faculty evaluation of written sign-out.
abstract: OBJECTIVE
  Recently the Accreditation Council for Graduate Medical Education mandated decreased shift duration for intern physicians to no more than 16 hours. Such work-hour restrictions are likely to increase patient care hand-offs. It is well accepted that sign-out (i.e., hand-off) processes are error prone and lack standardization. Moreover, many residency programs do not evaluate sign-out. We designed and tested whether a sign-out evaluation process could be implemented to improve written sign-out.
  
  
  METHODS
  Based on observed sign-out deficiencies at our institution we adapted a simple curriculum incorporating the SIGNOUT mnemonic, which we paired with weekly faculty member evaluation and feedback on sign-out using a structured sign-out evaluation tool. Later in the week, written sign-out was independently scored by 2-blinded senior resident reviewers who compared the inclusion of sign-out content, organization, and readability.
  
  
  RESULTS
  Compared to baseline data in 128 written sign-outs, the pairing of a 1-page curriculum with weekly faculty member evaluation of written sign-out improved the inclusion of advanced directives from 38% to 69% (p < .001) and anticipatory guidance from a mean score of 1.8 (SD = 1.2) to 2.3 (SD = 1.5) on a 5-point scale (p = .01) in 177 written sign-outs. Readability and organization were unchanged.
  
  
  CONCLUSIONS
  A simple curriculum paired with structured faculty evaluation and feedback can improve some parameters of sign-out. Structured evaluative sign-out tools may be useful to improve and teach sign-out skills.
authors: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA. bumpgm@upmc.edu
authors: Gregory M
authors: GM
authors: Bump
authors: Jerry
authors: J
authors: Jacob
authors: Saddam S
authors: SS
authors: Abisse
authors: James E
authors: JE
authors: Bost
authors: D Michael
authors: DM
authors: Elnicki
mesh_terms: D000704:Analysis of Variance; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods; D004521:Educational Measurement / Q000379:methods*; D005180:Faculty, Medical; D006801:Humans; D007858:Learning; D005791:Patient Care / Q000379:methods*; D013663:Teaching / Q000379:methods*; D014956:Writing