Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey

Abstract

Background: During sign-out (handover of care), information and responsibility about patients is transferred from one set of caregivers to another. Few residency training programmes formally teach resident physicians how to sign out or assess their ability to sign out, and little research has examined the sign-out process. Objective: To characterise the effectiveness of the signout process between resident physicians on an acute care ward. Design/methods: Resident physicians rotating on a paediatric acute care ward participated in a prospective study. Immediately after an on-call night, they completed a confidential survey characterising their night on call, the adequacy of the sign-out they received, and where they went to get information they had not received during signout. Results: 158 of 196 (81%) potential surveys were collected. On 49/158 surveys (31%), residents indicated something happened while on call they were not adequately prepared for. In 40/49 instances residents did not receive information during sign-out that would have been helpful, and in 33/40 the situation could have been anticipated and discussed during sign-out. The quality of sign-out (assessed using a five-point Likert scale from 1 = inadequate to answer call questions to 5 = adequate to answer call questions) on the nights when something happened the resident was not adequately prepared for were significantly different than the nights they felt adequately prepared (mean (SD) score 3.58 (0.92) and 4.48 (0.70); p = 0.001). There were no significant differences in: how busy the nights were; numbers of patients on service at the beginning of the call shift; numbers of admissions during a call shift; numbers of transfers to an intensive care unit; whether residents were ''cross-covering'' or were members of the general ward team; or whether the resident had cared for the patient previously. Conclusion: Although sign-out between resident physicians is a frequent activity, there are many times when important information is not transmitted. Analysis of these ''missed opportunities'' can be used to help develop an educational programme for resident physicians on how to sign out more effectively.Sign-out (handover of care) is a mechanism of transferring information, responsibility, and authority from one set of caregivers to another set of caregivers.

Are weekend handovers of adequate quality for the on-call general medical team?

“…18 Additionally, many patients whose cases were handed over on handwritten notes and not discussed at the meeting were recognised as being unwell after the meeting.…”

“…It gives the opportunity to explain the rationale for plans so that the on-call team can respond to any unanticipated events. 18 Many patients at the weekend needed review of conditions particular to a medical specialty with which a junior doctor on call may not be familiar -the meeting provides a valuable educational opportunity to discuss management of a diverse range of medical conditions. Given the importance of handover, the Academy of Medical Royal Colleges, the British Medical Association and the National Patient Safety Agency have published guidelines for safe medical handover.…”

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

“…The study suggests that these may have been linked to inadequate handover, as the quality of handover was rated below average on nights when something happened. 35 Some of the consequences and adverse events associated with inadequate handover include hospital complications and increased length of stay following multiple handovers, 36 treatment delays, 20,37 repetition of assessments, 38 confusion regarding care, 39,40 inaccurate clinical assessments and diagnosis and medication errors, 41 and avoidable readmissions and increased costs.…”

Development of a Structured Year-End Sign-Out Program in an Outpatient Continuity Practice

“…3,[11][12][13][14][15] The first form, called the Ten Tasks List (see Appendix available online), was a checklist of ten individual outstanding patient care tasks to be addressed by the intern within the first 3 months of the academic year. Patient care tasks were limited to the following five categories: (1) laboratory, (2) radiology, (3) medication, (4) specialist consultation, and (5) advance directives.…”