A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours

Eaton, Erik G. Van; Horvath, Karen D.; Lober, William B.; Rossini, Anthony; Pellegrini, Carlos A.

doi:10.1016/j.jamcollsurg.2004.11.009

Cited by 235 publications

(165 citation statements)

References 10 publications

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“…Findings include: (1) problematic shift models common to residency programs in the US undermine direct physician communication and increase the number of handoffs, reducing the quality of the verbal handoff [6][7][8][9] ; (2) written handoffs are wrought with variability and content omissions 7 ; (3) electronic templates can mitigate handoff problems. 10,11 The aforementioned research has led to several recommendations for interventions to improve handoffs. 1,2,5,6,[12][13][14] The few published intervention studies have not examined patient safety events as outcomes, leading experts to question the utility of standardization of handoffs as a patient safety initiative.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

et al. 2013

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BACKGROUND: Poor quality handoffs have been identified as a major patient safety issue. In residency programs, problematic handoffs may be an unintended consequence of duty-hour restrictions, and key data are frequently omitted from written handoffs because of the lack of standardization of content. OBJECTIVE: Determine whether an intervention that facilitates face-to-face communication supported by an electronic template improves the quality and safety of handoffs. DESIGN: Before-after trial. PARTICIPANTS: Thirty-nine interns providing nighttime coverage over 132 intern shifts, representing ∼9,200 handoffs. INTERVENTIONS: Two interventions were implemented serially-an alteration of the shift model to facilitate face-to-face verbal communication between the primary and nighttime covering physicians and an electronic template for the day-to-night handoff. MEASUREMENTS: Overall satisfaction and handoff quality were measured using a survey tool administered at the end of each intern shift. Written handoff quality, specifically the documentation of key components, was also assessed before and after the template intervention by study investigators. Interns used the survey tool to report patient safety events related to poor quality handoffs, which were validated by study investigators. RESULTS: In adjusted analyses comparing intern cohorts with similar levels of training, overall satisfaction with the new handoff processes improved significantly (p<0.001) post intervention. Verbal handoff quality (4/ 10 measures) and written handoff quality (5/6 measures) also improved significantly. Study investigators also found significant improvement in documentation of key components in the written handoff. Interns reported significantly fewer reported data omissions (p=0.001) and a non-significant reduction in near misses (p=0.056), but no significant difference in adverse events (p=0.41) post intervention.

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Section: Discussionmentioning

confidence: 99%

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

et al. 2013

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“…13,14,16,19,24,25 We have developed a tool to support patient tracking, sign-out, and rounding that incorporates key elements of previously designed systems and may improve communication among providers. SynopSIS helps to fulfill the 2006 JCAHO accreditation requirement for standardized communication for transfers of care when used with appropriate verbal communication, including an opportunity to ask and respond to questions.…”

Section: Discussionmentioning

confidence: 99%

“…We reviewed the literature to incorporate key design elements of other successfully implemented information transfer systems. 24,25 We conducted a formal review of existing patient-tracking and sign-out systems at our hospital to characterize provider work practices, with an emphasis on the specific information requirements of different specialties. A needs assessment of current sign-out processes at UCSFMC was conducted by personal interviews with a chief resident or representative of each of the 18 Accreditation Council of Graduate Medical Education (ACGME) accredited residency programs through the dean's office of Graduate Medical Education.…”

Section: Development and Designmentioning

confidence: 99%

“…24,25 In a randomized trial, UWCores was shown to improve indicators of quality of care (more time spent with patients on rounds, fewer patients missed on rounds) and rounding efficiency (less time prerounding and rounding). 25 For evaluation, we plan to use a previously published instrument 25 in an online survey of SynopSIS users to assess perceived changes in the quality of sign-out, provider-provider communication, and patient continuity of care. We intend to measure daily use of SynopSIS by primary providers, covering providers, and consulting physicians in order to assess its impact on each patient's care plan.…”

Section: Program Evaluationmentioning

confidence: 99%

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SynopSIS: Integrating physician sign‐out with the electronic medical record

Sarkar

Carter

Omachi

et al. 2007

Journal of Hospital Medicine

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BACKGROUNDSafe delivery of care depends on effective communication among all health care providers, especially during transfers of care. The traditional medical chart does not adequately support such communication. We designed a patient‐tracking tool that enhances provider communication and supports clinical decision making.AIMTo develop a problem‐based patient‐tracking tool, called Sign‐out, Information Retrieval, and Summary (SynopSIS), in order to support patient tracking, transfers of care (ie, sign‐outs), and daily rounds.SETTINGTertiary‐care, university‐based teaching hospital.PROGRAM DESCRIPTIONSynopSIS compiles and organizes information from the electronic medical record to support hospital discharge and disposition decisions, daily provider decisions, and overnight or cross‐coverage decisions. It reflects the provider's patient‐care and daily work‐flow needs.PROGRAM EVALUATIONWe plan to use Web‐based surveys, audits of daily use, and interdisciplinary focus groups to evaluate SynopSIS's impact on communication between providers, quality of sign‐out, patient continuity of care, and rounding efficiency.CONCLUSIONSWe expect SynopSIS to improve care by facilitating communication between care teams, standardizing sign‐out, and automating daily review of clinical and laboratory trends. SynopSIS redesigns the clinical chart to better serve provider and patient needs. Journal of Hospital Medicine 2007;2:336–342. © 2007 Society of Hospital Medicine.

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“…9 Web-based signout systems reportedly reduced the number of patients missed on rounds. 10 Hospitalists also face challenges with effective communication during service change. 11 The Society of Hospital Medicine identified the handoff skill as a core competency for hospitalists, and recommendations based on a systematic review of the literature were published.…”

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confidence: 99%

Gaining efficiency and satisfaction in the handoff process

Burton

Kashiwagi

Kirkland

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Handoffs, or transfers of patient care responsibility, occur frequently on hospitalist teams. The reliability and efficiency of the handoff process is a national and local concern. Most studies in the literature regard physicians‐in‐training. We studied the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants.METHODS:An improvement team observed morning handoffs. Four problems were identified: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in‐room conversations), and poor communication. The team restructured the process and observed post‐intervention behavior at 15 and 90 days. A participant‐provider survey was conducted before and after the intervention regarding wasted time, total time‐in‐report, and satisfaction with the process.RESULTS:Pre‐intervention 60.5% of providers (23/38) believed morning handoff was performed in a timely fashion compared to 100% (15/15) post‐intervention (P = 0.005). Average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention (P < 0.0028). Pre‐intervention 6.5 minutes were believed wasteful, compared to 0.5 minutes post‐intervention (P < 0.0001).CONCLUSIONS:This study identifies deficiencies in the handoff process that were addressed by enhancing the physical environment (smaller room, noise reduction, closed door), assigned seating (visual cues by table tent cards), non‐clinicians providing printed materials, standardization of written updates, team times (consistent & precise daily time for each team report), culture change including deference of attention to team receiving report with opportunity for questions, and minimization of side conversations. This intervention package resulted in an improvement in satisfaction and timeliness of clinicians involved. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours

Cited by 235 publications

References 10 publications

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

Effect of a Systems Intervention on the Quality and Safety of Patient Handoffs in an Internal Medicine Residency Program

SynopSIS: Integrating physician sign‐out with the electronic medical record

Gaining efficiency and satisfaction in the handoff process

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