title: Effectiveness of written hospitalist sign-outs in answering overnight inquiries.
abstract: BACKGROUND
  Hospitalists are key providers of care to medical inpatients, and sign-out is an integral part of providing safe, high-quality inpatient care. There is little known about hospitalist-to-hospitalist sign-out.
  
  
  OBJECTIVE
  To evaluate the quality of hospitalist/physician-extender sign-outs by assessing how well the sign-out prepares the night team for overnight events and to determine attributes of effective sign-out.
  
  
  METHODS
  Analysis of a written-only sign-out protocol on a nonteaching hospitalist service using prospective data collected by an attending physician survey during overnight shifts.
  
  
  METHODS
  Yale-New Haven Hospital, a 966-bed, urban, academic medical center in New Haven, Connecticut with approximately 13,700 hospitalist discharges annually.
  
  
  RESULTS
  We recorded 124 inquiries about 96 patients during 6 days of data collection in 2012. Hospitalists referenced the sign-out for 89 (74%) inquiries, and the sign-out was considered sufficient in isolation to respond to 27 (30%) of these inquiries. Hospitalists physically saw the patient for 14 (12%) of inquiries. Nurses were the originator for most inquiries (102 [82%]). The most common inquiry topics were medications (55 [45%]), plan of care (26 [21%]), and clinical changes (26 [21%]). Ninety-five (77%) inquiries were considered to be "somewhat" or "very" clinically important by the hospitalist.
  
  
  CONCLUSIONS
  Overall, we found that attending hospitalists rely heavily on written sign-out to address overnight inquiries, but that those sign-outs are not reliably effective. Future work to better understand the roles of written and verbal components in sign-out is needed to help improve the safety of overnight care.
authors.affiliation: Section of General Internal Medicine, Yale University School of Medicine, and Yale-New Haven Hospital Hospitalist Service, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Fogerty
authors.forename: Amy
authors.initials: A
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: D000046:Academic Medical Centers / Q000379:methods / Q000458:organization & administration / Q000639:trends; D003142:Communication; D003237:Connecticut; D057286:Electronic Health Records; D020445:Hospitalists / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D010043:Outcome and Process Assessment, Health Care; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*