title: Who's covering our loved ones: surprising barriers in the sign-out process.
abstract: BACKGROUND
  The aims of this study were to characterize obstacles affecting current sign-out practices and to evaluate the potential impact of standardized sign-out guidelines.
  
  
  METHODS
  In June 2011, detailed guidelines for transitions of care were implemented, and a 29-item multiple-choice survey was developed to assess sign-out practices, attitudes, and barriers to effective communication. Surveys were administered to residents and nurses at 3 time points. Comparisons between time points were assessed using t tests and χ(2) tests (α = .05).
  
  
  RESULTS
  Guideline implementation achieved nonsignificant improvements in satisfaction with sign-outs, perceptions of patient safety, adequacy of information provided in sign-out, and patient knowledge by on-call residents. On follow-up, concerns surfaced regarding less complete sign-out processes due to new duty-hour restrictions.
  
  
  CONCLUSIONS
  Guideline implementation mildly improved perceptions of safety and adequacy of sign-out; however, persistent barriers to continuity of care remain. Sign-out standardization may not adequately ensure patient safety, and further efforts to improve handoff processes are in need.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Mara B
authors.initials: MB
authors.lastname: Antonoff
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Berdan
authors.forename: Varvara A
authors.initials: VA
authors.lastname: Kirchner
authors.forename: Tara C
authors.initials: TC
authors.lastname: Krosch
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Holley
authors.forename: Michael A
authors.initials: MA
authors.lastname: Maddaus
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000592:standards*; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D008910:Minnesota; D009741:Nursing Staff, Hospital; D062209:Patient Handoff / Q000592:standards*; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires