title: Development of a structured year-end sign-out program in an outpatient continuity practice.
abstract: BACKGROUND
  In an effort to prevent medical errors, it has been recommended that all healthcare organizations implement a standardized approach to communicating patient information during transitions of care between providers. Most research on these transitions has been conducted in the inpatient setting, with relatively few studies conducted in the outpatient setting.
  
  
  OBJECTIVE
  To develop a structured transfer of care program in an academic outpatient continuity practice and evaluate whether this program improved patient safety as measured by the documented completion of patient care tasks at 3 months post-transition.
  
  
  METHODS
  Graduating residents and the corresponding incoming interns inheriting their continuity patient panels were randomized to the pilot structured transfer group or the standard transfer group. The structured transfer group residents were asked to complete written and verbal sign-outs with their interns; the standard transfer group residents continued the current standard of care.
  
  
  METHODS
  Thirty-two resident-intern pairs in an academic internal medicine residency program in New York City.
  
  
  METHODS
  Three months after the transition, study investigators evaluated whether patient care tasks assigned by the graduating residents had been successfully completed by the interns in both groups. In addition, follow-up appointments, continuity of care and house officer satisfaction with the sign-out process were evaluated.
  
  
  RESULTS
  Among patients seen during the first 3 months, the clinical care tasks were more likely to be completed by interns in the structured group (73 %, n = 49) versus the standard group (46 %, n = 28) (adjusted OR 3.21; 95 % CI 1.55-6.62; p = 0.002). This was further enhanced if the intern who saw the patient was also the assigned primary care provider (adjusted OR 4.26; 95 % CI 1.7-10.63; p = 0.002).
  
  
  CONCLUSIONS
  A structured outpatient sign-out improved the odds of follow-up of important clinical care tasks after the year-end resident clinic transition. Further efforts should be made to improve residents' competency with regard to sign-outs in the ambulatory setting.
authors.affiliation: Division of General Internal Medicine, New York University-Langone Medical Center, New York, NY, USA.
authors.forename: Ann R
authors.initials: AR
authors.lastname: Garment
authors.forename: Wei Wei
authors.initials: WW
authors.lastname: Lee
authors.forename: Christina
authors.initials: C
authors.lastname: Harris
authors.forename: Erica
authors.initials: E
authors.lastname: Phillips-Caesar
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards; D007400:Interprofessional Relations; D019300:Medical Errors / Q000517:prevention & control; D009519:New York City; D010360:Patient Transfer / Q000458:organization & administration*; D010865:Pilot Projects; D015397:Program Evaluation