Organizing the transfer of patient care information: the development of a computerized resident sign-out system

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

“…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.…”

“…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.…”

“…The report is generated for all patients assigned to an inpatient service (eg, Medicine Team B) and emphasizes clarity and brevity using a format validated in the medical literature. 24,25 Each patient's report covers one fourth of a standard 8 1 ⁄2-by-11-inch landscape-printed page. The top half of each of these quarter-page patient reports displays data stored in SynopSIS's interface and summarizes the patient's illness and the course of that illness.…”

“…We adapted elements of SynopSIS from UWCores, an existing sign-out application in place at the University of Washington. 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.…”

From the certainty of information transfer to the ambiguity of intuition

“…Handover, which is used interchangeably for signover (Perry, 2004), handoff or signout (Van Eaton et al, 2004), is "a mechanism for transferring information, primary responsibility, and authority from one or a set of caregivers to oncoming staff." (Perry, 2004) Generally speaking, handovers between shifts aim at preserving the flow of activities -ideally, so that the oncoming person can act and interact as if they had been present and engaged in all the previous activities (Patterson, 2001).…”