Inter-unit resident handoffs involves the transfer of information, responsibility and authority between sending and receiving units. In this exploratory study, we highlight the nature of questions and responses communicated during inter-unit handoffs and discuss their potential implications for the design of handoff tools and training of clinicians.
Objective
Effective sign-outs involve verbal communication supported by written or electronic documentation. We investigated the clinical content overlap between sign-out documentation and face-to-face verbal sign-out communication.
Methods
We audio-recorded resident verbal sign-out communication and collected electronically completed (“written”) sign-out documentation on 44 sign-outs in a General Medicine service. A content analysis framework with nine sign-out elements was used to qualitatively code both written and verbal sign-out content. A content overlap framework based on the comparative analysis between written and verbal sign-out content characterized how much written content was verbally communicated. Using this framework, we computed the full, partial, and no overlap between written and verbal content.
Results
We found high a high degree of full overlap on patient identifying information [name (present in 100% of sign-outs), age (96%), and gender (87%)], past medical history [hematology (100%), renal (100%), cardiology (79%), and GI (67%)], and tasks to-do (97%); lesser degree of overlap for active problems (46%), anticipatory guidance (46%), medications/treatments (15%), pending labs/studies/procedures (7%); and no overlap for code status (<1%), allergies (0%) and medical record number (0%).
Discussion and Conclusion
Three core functions of sign-outs are transfer of information, responsibility, and accountability. The overlap—highlighting what written content was communicated—characterizes how these functions manifest during sign-outs. Transfer of information varied with patient identifying information being explicitly communicated and remaining content being inconsistently communicated. Transfer of responsibility was explicit, with all pending and future tasks being communicated. Transfer of accountability was limited, with limited discussion of written contingency plans.
Studies have highlighted the importance of using objective physiological measures in quickly identifying critical patients who are at an increased risk of clinical deterioration and decompensation. In this exploratory study, we investigate the use of physiological measures within a modified Patient at Risk (PAR) framework for identifying potential ICU admissions during ED-MICU handoffs.
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