The Impact of Inpatient Electronic Sign-out on Quality and Patient Safety

Mohammad U. Malik^1, , Amibahen Gandhi¹, Hassan Tahir¹, Jhanavi Sagi¹, Sandhya Narukonda¹, Thomas Simunich¹, Saba Waseem¹ and Medha Joshi¹

¹Internal Medicine Conemaugh Health System, Johnstown, PA

Cite this paper

Mohammad U. Malik, Amibahen Gandhi, Hassan Tahir, Jhanavi Sagi, Sandhya Narukonda, Thomas Simunich, Saba Waseem and Medha Joshi. The Impact of Inpatient Electronic Sign-out on Quality and Patient Safety. American Journal of Public Health Research. 2016; 4(4):149-153. doi: 10.12691/AJPHR-4-4-5

Abstract

Introduction: The transition of patient care to the resident on call during the sign-out/hand off is an integral part of residency training and is a time vulnerable to medical errors. Methods: Authors conducted the study from July 28^th to December 14^th 2014. Residents (n=26) were required to sign-out via the electronically via the SBAR (Situation-Background-Assessment-Recommendation) based electronic template. The quality of sign-out was assessed by night float questionnaire. The quality of the sign-out (scale 1 to 5), preventable morbidities, LOS, mortalities and readmissions were compared pre and post intervention for the admitted patients (pre= 184, post=172). Results: Improvement in the mean quality (Likert scale 1-5) of both the written sign-out, 3.0 to 3.8 (p<0.001), and verbal sign-out, 3.0 to 3.6 (p=0.002) (n=22 pre and post), was found. The preventable morbidities decreased from 10% to 5% (p=0.047). No statistically significant difference was noted for lethal morbidities, length of stay or readmissions. Conclusion: Implementation of electronic sign-out in addition to verbal sign-out improved the quality of sign-out with trend towards reduction in morbidities. The electronic sign-out may provide key information and help the on call team to make better decisions regarding the patient care.

Keywords

sign-out, transition of care, residency training, quality improvement, performance improvement

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Wohlauer MV, Arora VM, Horwitz LI, Bass EJ, Mahar SE, Philibert I. The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care. Acad Med 2012;87:411-418.
[2]	http://www.acgme.org/What-We-Do/Accreditation/Duty-Hours. The ACGME Duty Hours.
[3]	Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med 2006;166:1173-1177.
[4]	McCrory MC, Aboumatar H, Custer JW, Yang CP, Hunt EA. “ABC-SBAR” training improves simulated critical patient hand-off by pediatric interns. Pediatr Emerg Care 2012;28:538-543.
[5]	Vawdrey DK, Stein DM, Fred MR, Bostwick SB, Stetson PD. Implementation of a computerized patient handoff application. AMIA Annu Symp Proc 2013;2013:1395-1400.
[6]	Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC. I-pass, a mnemonic to standardize verbal handoffs. Pediatrics 2012;129: 201-204.
[7]	Starmer AJ, Sectish TC, Simon DW et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA 2013;310: 2262-2270.
[8]	Starmer AJ, Spector ND, Srivastava R et al. Changes in medical errors after implementation of a handoff program. N Engl J Med 2014; 371:1803-1812.
[9]	Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 2006;32:167-175.
[10]	www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_07012016.pdf. ACGME Common Program Requirements 2016.
[11]	Dekosky AS, Gangopadhyaya A, Chan B, Arora VM. Improving Written Sign-Outs Through Education and Structured Audit: The UPDATED Approach. J Grad Med Educ 2013;5:335-336.
[12]	Lee JC, Horst M, Rogers A et al. Checklist-styled daily sign-out rounds improve hospital throughput in a major trauma center. Am Surg 2014;80:434-440.
[13]	Oak SN, Dave NM, Garasia MB, Parelkar SV. Surgical checklist application and its impact on patient safety in pediatric surgery. J Postgrad Med 2015;61:92-94.
[14]	Agarwal HS, Saville BR, Slayton JM et al. Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational sustainability and improved team performance*. Crit Care Med 2012;40:2109-2115.
[15]	Graham KL, Marcantonio ER, Huang GC, Yang J, Davis RB, Smith CC. Effect of a systems intervention on the quality and safety of patient handoffs in an internal medicine residency program. J Gen Intern Med 2013;28:986-993.
[16]	Gonzalo JD, Yang JJ, Stuckey HL, Fischer CM, Sanchez LD, Herzig SJ. Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. Int J Qual Health Care 2014;26:337-347.
[17]	Inaba K, Recinos G, Teixeira PG et al. Complications and death at the start of the new academic year: is there a July phenomenon? J Trauma 2010;68:19-22.
[18]	Shulkin DJ. The July phenomenon revisited: are hospital complications associated with new house staff? Am J Med Qual 1995;10:14-17.
[19]	Levy K, Voit J, Gupta A, Petrilli CM, Chopra V. Examining the July Effect: A National Survey of Academic Leaders in Medicine. Am J Med 2016;129:754-755.
[20]	Petrilli CM, Del VJ, Chopra V. Why July Matters. Acad Med 2016;91:910-912.
[21]	Lied TR, Kazandjian VA. A Hawthorne strategy: implications for performance measurement and improvement. Clin Perform Qual Health Care 1998;6:201-204.