“Who’s that patient again?”: Standardizing Sign-Out to improve Patient Care A Resident-Led Quality Improvement Project

From the 2023 HVPA National Conference

Moeen Aboabdo MBBCh, MPH (Temple University Hospital), Shreya Makkapati MD, Lauren Tragesser MD, Emily Cunnings MD, Harry Wine MD, MS, Jamey Moore DO, Nicholas Talabiska DO, David Blake MD, Si Li MD

Introduction:
Transitions of care are a crucial aspect of healthcare. The large transition at the end of the work week as one team leaves service and another starts has been at the center of efforts from the American Medical Association (AMA) to improve patient safety outcomes. Standardized sign-out has been shown to reduce the costs associated with length of stay in large hospital systems and has been shown to decrease pre-rounding time for residents improving their compliance with 80-hour work weeks.

Objective:
With this project we aimed to create a standardized process for weekly sign-out for an Internal Medicine Residency program in an academic urban hospital.

Methods:
An initial 9-point survey instrument was created to assess residents’ satisfaction with the current sign-out process. Residents were educated on a sign-out electronic health record macro, also known as a dot-phrase, that was created using feedback from the initial survey. Subsequently, after 4 weeks of implementing the new sign-out process the same 9-point survey was circulated to the residency to better understand resident satisfaction with the change.
We compared the pre-survey and post-survey data by using Pearson’s chi-squared test for categorical variables to assess the likelihood that any observed differences between the groups occurred by chance. We also created density-distribution sunflower plots to display bivariate data. Statistical significance was considered at a p value of 0.05.

Results:
N=48 respondents responded to our pre-survey; N=21 responded to our post-survey. After implementation of a standardized sign-out process 76.13% of residents agreed/strongly agreed that the sign-out process made them feel prepared for the week and 76.19% of residents agreed/strongly agreed that the new sign-out process made them feel better prepared for the discharge plan.

Conclusions:
A standardized sign-out process made residents feel more prepared for patient management when transitioning to a new medical team.

Clinical Implication:
Standardized sign-out processes allow residents to feel better prepared for the week and can improve understanding for the discharge plan leading to reduced patient length of stay and improve overall patient care.

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