title: Implementation of an emergency department sign-out checklist improves transfer of information at shift change.
abstract: BACKGROUND
  Transitions of care are ubiquitous in the emergency department (ED) and inevitably introduce the opportunity for errors. Few emergency medicine residency programs provide formal training or a standard process for patient handoffs. Checklists have been shown to be effective quality-improvement measures in inpatient settings and may be a feasible method to improve ED handoffs.
  
  
  OBJECTIVE
  To determine if the use of a sign-out checklist improves the accuracy and efficiency of resident sign-out in the ED.
  
  
  METHODS
  A prospective pre-/postinterventional study of residents rotating in the ED at a tertiary academic medical center. Trained research assistants observed resident sign-out during shift change over a 2-week period and completed a data collection tool to indicate whether or not key components of sign-out occurred and time to sign out each patient. An electronic sign-out checklist was implemented using a multi-faceted educational effort. A 2-week postintervention observation phase was conducted. Proportions, means, and nonparametric comparison tests were calculated using STATA.
  
  
  RESULTS
  One hundred fifteen sign-outs were observed prior to checklist implementation and 114 were observed after. Significant improvements were seen in four sign-out components: reporting of history of present illness increased from 81% to 99%, ED course increased from 75% to 86%, likely diagnosis increased from 60% to 77%, and team awareness of plan increased from 21% to 41%. Use of the repeat-back technique decreased from 13% to 5% after checklist implementation and time to sign-out showed no significant change.
  
  
  CONCLUSIONS
  Implementation of a checklist improved the transfer of information without increasing time to sign-out.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Dubosh
authors.affiliation: Department of Emergency Medicine, University of California at San Francisco, San Francisco, CA.
authors.forename: Dylan
authors.initials: D
authors.lastname: Carney
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Carrie D
authors.initials: CD
authors.lastname: Tibbles
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000592:standards; D057189:Checklist; D003142:Communication; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards; D010561:Personnel Staffing and Scheduling; D010865:Pilot Projects; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D013997:Time Factors
keywords: checklist; emergency department; handoffs; resident education; sign-out