CHARACTERIZATION OF SIGN-OUT IN PEDIATRIC ACUTE CARE WARDS TO INFORM PROCESS IMPROVEMENT

摘要

Physician sign-out is a mechanism for transferring patient information, responsibility, and authority from one set of hospital caregivers to another at shift changes. This project characterized the information exchanged between physicians during 15 sign-outs, and analyzed data from 158 post-call resident surveys. Ten categories of patient information were developed to characterize the exchanged information. Of the ten categories of patient information, no single category was discussed for every patient. The information critically important to discuss during sign-out was often the least covered, as residents discussed the patient’s current physical condition for only 35% of the patients, current medications for only 63% of patients, and contingency plans for possible scenarios for only 17.7% of patients. On average, residents discussed 14 patients during each sign-out, with the average sign-out lasting 35 minutes (2:28 minutes/patient). Of the total sign-out duration, approximately 23% of the time was spent discussing matters not related to patient care. Of the time spent “on-task”, 32.2% was spent on patient background, which could be obtained from other data sources. Very little time was spent discussing information which may not be available elsewhere, such as what actions, both planned and contingency, should occur overnight. Such information only received 12.1% of the sign-out time. 49 out of 158 resident surveys (31.0%) revealed that residents experienced an event while on call that they were unprepared to handle. Of those cases, 82% were the result of missing information. These data create a baseline understanding of sign-out which should be used to inform potential process and training improvements to ensure that the appropriate information is discussed for each patient.