Interruptions During Sign-out Between Emergency Medicine Residents Before and After Implementation of Group Sign-out Process

Abstract

Introduction Interruptions that occur during sign-out in the emergency department (ED) may affect workflow, quality of care, patient safety, errors in documentation, and resident education. Our objective in this study was to determine the frequency and classification (emergent vs non-emergent, in-person vs phone call) of interruptions that occur during emergency medicine (EM) resident sign-out before and after the institution of a group sign-out process involving residents and attending physicians. Methods A convenience sample of sign-out observations between EM residents were observed and coded between April–December 2021. We excluded sign-out observations of pediatric patients (<18 years of age) and observations not conducted in the main ED. Collected data included number of patients signed out during each observation; total duration in minutes for each observation; total number of interruptions during each observation; and type of interruption (emergent vs non-emergent, in-person vs phone call). We further stratified data before and after the institution of a group sign-out process (July 2021). Results We performed data analysis on 58 individual and 65 group sign-out observations, respectively. Although the total number of patients signed out, the total duration of sign-outs observed, mean number of patients signed out per minute, and mean duration of sign-out per observation were more for the group sign-out aggregate compared with the individual sign-out aggregate, the total number of interruptions (44 vs 73, P = 0.007), number of interruptions per minute (0.05 vs 0.16, P < 0.001), total number of non-emergent interruptions (38 vs. 67, P = 0.005), and total number of in-person interruptions (14 vs 44, P < 0.001) was less in the group sign-out compared with the individual sign-out totals. Conclusion Based on our sample, although the total duration of group sign-out with both residents and an attending was longer than individual resident-to-resident sign-out, the total number of interruptions, number of interruptions per minute, total number of non-emergent interruptions, and total number of in-person interruptions was less in the group sign-out. Group sign-out may be an option to limit the negative effects of interruptions in the ED.