Sign-out snapshot: cross-sectional evaluation of written sign-outs among specialties

Schoenfeld, Amy; Al‐Damluji, Mohammed Salim; Horwitz, Leora I.

doi:10.1136/bmjqs-2013-002164

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…26 An observational study found that that only 11% included ''Do Not Resuscitate'' or advance directive information, and only 50% of successive handoffs were updated daily. 53 Another study found that 96% of electronic handoffs were updated within 24 hours, 51 while a third study found an increase in the documentation of 12 of 16 specific data elements studied, a decrease in 3 elements, and no difference in 1 element. 48 Three studies noted that an electronic handoff tool should include free-text options for current anticipatory guidance and comments, 25,35,48 and another reported that users need to be encouraged to be vigilant in revising and updating free-text sections.…”

Section: Process Measuresmentioning

confidence: 99%

“…22,[24][25][26]28,29,35,[44][45][46][47][48][49][50][51][52] One study found that 92% of errors were committed in a core data element and could have been prevented with auto-population. 44 While many studies with process outcomes specifically showed fewer data omissions, 24,25,28,29,34,44-47,49-52 1 found that less than 50% included allergies or code status when using the electronic handoff system.…”

Section: Process Measuresmentioning

confidence: 99%

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Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

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Background Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care. Objective This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs. Methods We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures. Results Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements. Conclusions The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.

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Section: Process Measuresmentioning

confidence: 99%

Section: Process Measuresmentioning

confidence: 99%

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Davis¹,

Riesenberg²,

Mardis³

et al. 2015

Journal of Graduate Medical Education

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“…During overnight shifts, traditionally a time without direct attending supervision, the cross-covering resident receives the first call when a patient develops a fever. Residents frequently provide anticipatory guidance for febrile episodes when they sign out their patients to fellow residents for overnight coverage [10,11]. At the study institution, the sign-out provides guidance regarding performing a "full fever work-up" (FFWU), although its definition is not standardized.…”

Section: Introductionmentioning

confidence: 99%

Internal medicine residents’ evaluation of fevers overnight

et al. 2019

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Background Scant data exists to guide the work-up for fever in hospitalized patients, and little is known about what diagnostic tests medicine residents order for such patients. We sought to analyze how cross-covering medicine residents address fever and how sign-out systems affect their response. Methods We conducted a prospective cohort study to evaluate febrile episodes that residents responded to overnight. Primary outcomes included diagnostic tests ordered, if an in-person evaluation occurred, and the effect of sign-out instructions that advised a “full fever work-up” (FFWU). Results Investigators reviewed 253 fevers in 155 patients; sign-out instructions were available for 204 fevers. Residents evaluated the patient in person in 29 (11%) episodes. The most common tests ordered were: blood cultures (48%), urinalysis (UA) with reflex culture (34%), and chest X-ray (30%). If the sign-out advised an FFWU, residents were more likely to order blood cultures [odds ratio (OR) 14.75, 95% confidence interval (CI) 7.52–28.90], UA with reflex culture (OR 12.07, 95% CI 5.56–23.23), chest X-ray (OR 16.55, 95% CI 7.03–39.94), lactate (OR 3.33, 95% CI 1.47–7.55), and complete blood count (CBC) (OR 3.16, 95% CI 1.17–8.51). In a multivariable regression, predictors of the number of tests ordered included hospital location, resident training level, timing of previous blood culture, in-person evaluation, escalation to a higher level of care, and sign-out instructions. Conclusions Sign-out instructions and a few patient factors significantly impacted cross-cover resident diagnostic test ordering for overnight fevers. This practice can be targeted in resident education to improve diagnostic reasoning and stewardship.

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“…Cross-covering patients overnight commonly occurs in academic medical centers. When providing sign-out instructions, resident physicians usually provide the cross-covering resident with anticipatory guidance on what to do if a patient has a fever [ 1 , 2 ]. Despite this being a frequent clinical scenario, there is surprisingly little evidence-based guidance on how to approach a fever in a hospitalized patient.…”

mentioning

confidence: 99%

Choosing Wisely Overnight? Residents’ Approach to Fever

Howard‐Anderson

Schwab

Quinn

et al. 2017

Open Forum Infectious Diseases

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Sign-out snapshot: cross-sectional evaluation of written sign-outs among specialties

Abstract: Background-Sign-out is the process (written, verbal, or both) by which one clinical team transmits information about patients to another team. Poor quality sign-outs are associated with adverse events and delayed treatment. How different specialties approach written sign-outs is unknown.

Cited by 11 publications

References 20 publications

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

Internal medicine residents’ evaluation of fevers overnight

Choosing Wisely Overnight? Residents’ Approach to Fever

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