title: Sign-out snapshot: cross-sectional evaluation of written sign-outs among specialties.
abstract: BACKGROUND
  Sign-out is the process (written, verbal or both) by which one clinical team transmits information about patients to another team. Poor quality sign-outs are associated with adverse events and delayed treatment. How different specialties approach written sign-outs is unknown.
  
  
  OBJECTIVE
  To compare written sign-out practices across specialties and to determine consistency of content, format and timeliness.
  
  
  METHODS
  The authors evaluated all non-Intensive Care Unit written sign-outs from five inpatient specialties on 18 January 2012, at Yale-New Haven Hospital, focusing on content elements, format style and whether the sign-outs had been updated within 24 h. In our institution, all specialties used a single standardised sign-out template, which was built into the electronic medical record.
  
  
  RESULTS
  The final cohort included 457 sign-outs: 313 medicine, 64 general surgery, 36 paediatrics, 30 obstetrics, and 14 gynaecology. Though nearly all sign-outs (96%) had been updated within 24 h, they frequently lacked key information. Hospital course prevalence ranged from 57% (gynaecology) to 100% (paediatrics) (p<0.001). Clinical condition prevalence ranged from 34% (surgery) to 72% (paediatrics) (p=0.005).
  
  
  CONCLUSIONS
  Specialties have varied sign-out practices, and thus structured templates alone do not guarantee inclusion of critical content. Sign-outs across specialties often lacked complex clinical information such as clinical condition, anticipatory guidance and overnight tasks.
authors.affiliation: Massachusetts General Hospital, , Boston, Massachusetts, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Schoenfeld
authors.forename: Mohammed
authors.initials: M
authors.lastname: Salim Al-Damluji
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
mesh_terms: D015331:Cohort Studies; D003237:Connecticut; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D006801:Humans; D007400:Interprofessional Relations; D019300:Medical Errors / Q000517:prevention & control*; D008511:Medicine / Q000706:statistics & numerical data; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team; D062209:Patient Handoff / Q000592:standards*; D010817:Physician-Patient Relations; D017064:Process Assessment, Health Care / Q000592:standards