title: Feedback to achieve improved sign-out technique.
abstract: To maximize the quality of sign-out documents within the internal medicine residency, a quality improvement intervention was developed and implemented. Written sign-outs were collected from general medicine ward teams and graded using an 11-point checklist; in-person feedback was then given directly to the ward teams. Documentation of many of the 11 elements improved: mental status (22% to 66%, P < .0001), decisionality (40% to 66%, P < .0001), lab/test results (63% to 69%, P < .0001), level of acuity (34% to 50%, P < .0001), anticipatory guidance (69% to 82%, P < .0001), and future plans (35% to 38%, P < .0005). The use of vague language declined (41% to 26%, P < .0001). The mean total scores improved from 7.0 to 8.2 out of a possible 11 (P < .0001). As new house staff rotated onto the services, improvement over time was sustained with 1 feedback session per team, per month. Similar interventions could be made in other programs and other institutions.
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Doers
authors.affiliation: University of Wisconsin, Madison, WI.
authors.forename: Poonam
authors.initials: P
authors.lastname: Beniwal-Patel
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI Clement J. Zablocki VA Medical Center, Milwaukee, WI.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kuester
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI Clement J. Zablocki VA Medical Center, Milwaukee, WI kfletche@mcw.edu.
authors.forename: Kathlyn E
authors.initials: KE
authors.lastname: Fletcher
mesh_terms: D057189:Checklist; D003266:Continuity of Patient Care; D005246:Feedback; D006769:Hospitals, General; D006801:Humans; D062209:Patient Handoff / Q000592:standards*; D061214:Patient Safety; D011446:Prospective Studies; D058996:Quality Improvement
keywords: care transitions; continuity of care; medical education-communication skills; medical student and residency education; patient safety