title: The Missing Record of Mental Status in Written Sign-Outs.
abstract: The aim of the study was to determine how frequently mental status and mental status changes are documented in the written patient summary ("sign-out") provided to covering physicians.
  
  
  
  This was a retrospective cohort study of general medical patients hospitalized between March 16, 2009, and March 15, 2010, conducted at 2 teaching hospitals. Participants included patients with mental status change adverse events (MSAEs) and their providers. Chart review was performed to identify patients with MSAEs and details about these events. Sign-outs were reviewed for documentation of mental status. Main outcome measures were (1) proportion of patients with MSAEs who had mental status ever recorded in sign-out entries and (2) the proportion of patients with MSAEs whose change in mental status was recorded in the sign-out.
  
  
  
  Sixty-eight patients had MSAEs and were included in the sample. Fifty percent of MSAEs were attributed to medications; 75% of these events were first detected by nurses. Only 25% of patients with MSAEs had their change in mental status recorded in sign-outs.
  
  
  
  Recording mental status in written sign-outs is uncommon. Particularly concerning is that patients with MSAEs identified by chart review seldom had sign-outs that reflected those events. Interventions should be designed to increase the recording of this information in sign-outs.
authors.affiliation: From the Department of Internal Medicine and Pediatrics, University of Buffalo, Buffalo, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Croix
authors.affiliation: Department of Internal Medicine, Division of Hospital Internal Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota.
authors.forename: Donna
authors.initials: D
authors.lastname: Miller
authors.affiliation: Clement J. Zablocki VAMC.|Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
authors.affiliation: Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Singh
authors.affiliation: Philadelphia VAMC.|Department of Internal Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carnahan
authors.affiliation: Clement J. Zablocki VAMC.|Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kuester
authors.affiliation: Clement J. Zablocki VAMC.
authors.forename: Christa
authors.initials: C
authors.lastname: Kallio
authors.affiliation: Clement J. Zablocki VAMC.
authors.forename: Susan
authors.initials: S
authors.lastname: Framberg
authors.affiliation: Clement J. Zablocki VAMC.|Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kathlyn E
authors.initials: KE
authors.lastname: Fletcher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003266:Continuity of Patient Care; D003693:Delirium; D004282:Documentation; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008499:Medical Records; D008603:Mental Health; D008875:Middle Aged; D010820:Physicians; D012189:Retrospective Studies; D014956:Writing