title: Changes in written sign-out composition across hospitalization.
abstract: BACKGROUND
  Inaccurate or incomplete information in the written portion of the patient handoff, or sign-out, may be associated with adverse events in hospitalized patients. Little is known about what information providers actually include in written sign-out documents and how sign-outs change over time.
  
  
  OBJECTIVE
  (1) Provide a descriptive analysis of initial and subsequent hospital day-written sign-out content, and (2) evaluate the relationship between team workload and sign-out composition.
  
  
  METHODS
  Retrospective review of sign-out documents from a larger observational study of general medicine patients admitted to housestaff and hospitalist teams at 3 hospitals.
  
  
  METHODS
  The presence of 13 components of a high-quality sign-out. We performed descriptive analyses and compared initial and subsequent day sign-outs for content.
  
  
  RESULTS
  We reviewed 200 patient hospitalizations (200 initial handoffs, 580 subsequent day handoffs). Initial sign-out entries contained a mean of 7.54 (standard deviation: 2.27) key sign-out components. Subsequent day sign-outs contained a higher percentage of certain key elements but had more vague language. The number of elements present in the sign-out was reduced as patient census increased (r = -0.295, P < 0.01).
  
  
  CONCLUSIONS
  Sign-out composition changes over time, and is associated with workload. Future interventions to improve quality should take these factors into consideration.
authors.affiliation: Department of Internal Medicine, Division of Hospital Internal Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Miller
authors.affiliation: Department of Internal Medicine, University of Pennsylvania Perelman School of Medicine and the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Visotcky
authors.affiliation: Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Purushottam
authors.initials: P
authors.lastname: Laud
authors.affiliation: Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Davie, Florida.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kordus
authors.affiliation: Department of Internal Medicine, Clement J. Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
authors.affiliation: Department of Internal Medicine, Clement J. Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, Clement J. Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kathlyn E
authors.initials: KE
authors.lastname: Fletcher
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends; D057286:Electronic Health Records / Q000592:standards* / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D062209:Patient Handoff / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies