SynopSIS: Integrating physician sign‐out with the electronic medical record

Abstract

BACKGROUNDSafe delivery of care depends on effective communication among all health care providers, especially during transfers of care. The traditional medical chart does not adequately support such communication. We designed a patient‐tracking tool that enhances provider communication and supports clinical decision making.AIMTo develop a problem‐based patient‐tracking tool, called Sign‐out, Information Retrieval, and Summary (SynopSIS), in order to support patient tracking, transfers of care (ie, sign‐outs), and daily rounds.SETTINGTertiary‐care, university‐based teaching hospital.PROGRAM DESCRIPTIONSynopSIS compiles and organizes information from the electronic medical record to support hospital discharge and disposition decisions, daily provider decisions, and overnight or cross‐coverage decisions. It reflects the provider's patient‐care and daily work‐flow needs.PROGRAM EVALUATIONWe plan to use Web‐based surveys, audits of daily use, and interdisciplinary focus groups to evaluate SynopSIS's impact on communication between providers, quality of sign‐out, patient continuity of care, and rounding efficiency.CONCLUSIONSWe expect SynopSIS to improve care by facilitating communication between care teams, standardizing sign‐out, and automating daily review of clinical and laboratory trends. SynopSIS redesigns the clinical chart to better serve provider and patient needs. Journal of Hospital Medicine 2007;2:336–342. © 2007 Society of Hospital Medicine.

The Computerized Rounding Report: Implementation of a Model System to Support Transitions of Care

“…This study joins others in demonstrating that a CSO tool is beneficial for residency programs seeking to support transitions of care and adapt to new ACGME requirements [14,19,20]. Survey data demonstrated a modest reduction in resident-reported time spent in pre-rounding activities and a reduction in the number of missed patients following implementation of the CSO.…”

Trial of shift scheduling with standardized sign-out to improve continuity of care in intensive care units*

“…Our cur riculum is similar in content and struc ture to recently published descriptions of signout curriculum (27,54,55). Approximately half of the fellows experi enced both arms of the study, and skills and attitudes acquired during the inter vention schedule and curriculum might have crossed over into control months, narrowing the ability to detect differ ences, as signouts in general improved as the year progressed.…”

“…Educational curriculum with computer ized prompts has been shown to improve continuity of care during handoffs (19,(23)(24)(25). Prior descriptions in nursing education suggest best evidence for effec tive communication during the handoffs in clinical care, and an increas ing body of literature on best practices for handoff is accumulating (26)(27)(28)(29). The most recent recommendations by the Joint Commis sion, Institute of Medicine, and Accredi tation Council for Graduate Medical Education require a method to document patient handoff procedures (9,11,30,31).…”

Electronic Medical Records and Quality Improvement

“…12 An excellent example is the use of EMRs to implement signout systems. [13][14][15][16][17] Sign-out systems pull current information, such as vital signs, fluids in and out, laboratory values, medications, active medical problems, and other clinical information, to provide the receiving physician with a concise summary of any given patient's current status, plans, and expected course. Such improvement in handoffs is currently a major Joint Commission National Patient Safety Goal.…”