Sep 15, 2020
Transitions of care are one of
the most dangerous activities in medicine. Numerous studies
highlight the rates of medical errors which occur at the time of
sign-outs. Formalized sign-out processes have been shown to
significantly decrease breakdowns in communication and reduce
adverse events. In this episode, Dr. Kaminsky sits
down with residents from across the country to dissect and discuss
different sign-out styles and share some insights regarding bias
and areas for improvement.
- Alex Kaminsky, MD -- UCSF,
- Rosemarie Diaz, MD – University
- Mary McLean, MD –
St. John's Riverside
- Nicholas Robbins, MD – John
Peter Smith Hospital
- Safer Sign Out Protocol: Available at ACEP.
- EMRA: Transitions of Care
- In a prospective
multi-center study (>10,000 patients) communication error
occurred at a rate pf 24.5 per 100 admissions. Preventable errors
were found to be 4.7 per 100 admissions.
- Effective sign-out strategies
have been shown to reduce overall medical errors by ~23% and
preventable adverse events by ~30%.
Remember CODE STATUS!
HPI, ED course/Ongoing assessment,
Action List: “To-do”
Situation Awareness and
Contingency Planning: “If
this, then do that.” Give your colleagues an idea of what to do if
an event occurs.
Synthesis by Receiver:
Person taking the sign out does a
“readback” of what they heard. Restate key actions. Also, the time
to ask questions.
and briefly define the situation
Provide clear, relevant background
information that relates to the situation.
A statement of your professional
Recommendation: What do you need from this individual?
What to do and contingencies.
S: Sick or not Sick
H: History and Hospital Course
U: Upcoming plan, disposition
T: To do
(note: This is by no means
a comprehensive list)
- Brady P, Gorham J, Kosti A,
et al "SHOUT" to
improve the quality of care delivered to patients with acute kidney
injury at Great Western Hospital. BMJ Open Quality 2015;4:u207938.w3198. doi: 10.1136/bmjquality.u207938.w3198
a Powerful Tool to Help Improve Communication.”
- Starmer AJ, Spector ND, Srivastava R, West DC,
Rosenbluth G, Allen AD, et al. Changes in medical errors after
implementation of a handoff program. N Engl J Med.
- Heilman JA, Flanigan M, Nelson A, Johnson T,
Yarris LM. Adapting the I-PASS Handoff Program for Emergency
Department Inter-Shift Handoffs. West J Emerg Med.
- Cheung DS, Kelly JJ, Beach C, Berkeley RP,
Bitterman RA, Broida RI, et al. Improving handoffs in the
emergency department. Ann Emerg Med. 2010;55(2):171-80.