Experience with Faculty Supervision of an Electronic Resident Sign-out System

Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review

“…Most studies that provided self-reported data on time devoted to activities related to handoffs showed reductions in time allocated to handoffs. 23,27,31,34,39,42 In contrast, in 1 study respondents self-reported a decrease in time devoted to handoff preparation and an increase in the amount of time needed to update handoff information. 32 Another study found conflicting results, with 37% of respondents reporting the electronic system was faster, and 57% reporting the card-based system (control) was faster to use.…”

“…[22][23][24][25][26][27]31,32 However, in 1 of these studies, 22.6% of respondents reported there was information they did not receive at handoff that would have helped them care for patients. 26 Other studies 22,25,30,33,36,37 noted that respondents reported increased quality of handoffs with an electronic handoff system.…”

“…21 Yet another study found no significant difference between the number of patients handed off and the time spent during handoff; however, the respondents reported an increase in perceived efficiency and ease of use. 22 In other studies questioning about use of the electronic system, 82% of respondents in 1 study 39 reported using the electronic system, and 84% of respondents in a second study 27 reported they would use the electronic system over other systems.…”

“…In 1 study, residents used 3 different handoff protocols (written, electronic, and face-to-face), with reports of protocol deviations lowest in the face-to-face phase (28%), highest with written handoffs (67%), and electronic handoffs falling in the middle (50%). 38 In 9 studies (24%), perception of patient safety and/or quality of care improved 22,27,31,36,39 ; better patient management 21,25 or fewer near misses 30 were reported; and there was a reduction in missed patients. 34 However, a randomized crossover study found no statistically significant differences in resident-reported unexpected events, medical errors, or adverse drug events when comparing the electronic handoff system to the standard systems used (ie, written lists, card based, or a team-developed spreadsheet), 40 and another study found no difference in reported unexpected events pre-to postimplementation of a new electronic handoff system.…”

A Multidisciplinary Approach for Teaching Systems-Based Practice to Internal Medicine Residents

“…Following a 2009 presentation of the AI program to our Graduate Medical Education Committee and the hospital board's quality council, the institution expanded the AI to permit participation by residents from other departments. Institutional financial support of AI-related projects has significantly increased annually, allowing us to enhance our sign-out software and to create a Center for EIP Quality Research, which now facilitates collaborative projects between residents, faculty, and quality improvement personnel-including our ongoing efforts to identify best hand-off practices 18 and to improve physician near-miss and adverse-events reporting through our handheld platform. Through end-of-rotation evaluations, our educators have noted that residents' insights have spurred important systems changes: near-miss and adverse-events reporting leading to improvements in how narcotics and insulin are ordered and how medications are dispensed; simulation training to better prepare residents to act as ''code team'' leaders; use of sign-out software instant-messaging capability to facilitate discharge planning, to permit correct provider-relaying of critical imaging and laboratory test results and to facilitate concurrent monitoring of National Hospital Quality Measures (core measures) by members of the quality staff.…”