American Journal of Public Health Research
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American Journal of Public Health Research. 2016, 4(4), 149-153
DOI: 10.12691/ajphr-4-4-5
Open AccessArticle

The Impact of Inpatient Electronic Sign-out on Quality and Patient Safety

Mohammad U. Malik1, , Amibahen Gandhi1, Hassan Tahir1, Jhanavi Sagi1, Sandhya Narukonda1, Thomas Simunich1, Saba Waseem1 and Medha Joshi1

1Internal Medicine Conemaugh Health System, Johnstown, PA

Pub. Date: July 16, 2016

Cite this paper:
Mohammad U. Malik, Amibahen Gandhi, Hassan Tahir, Jhanavi Sagi, Sandhya Narukonda, Thomas Simunich, Saba Waseem and Medha Joshi. The Impact of Inpatient Electronic Sign-out on Quality and Patient Safety. American Journal of Public Health Research. 2016; 4(4):149-153. doi: 10.12691/ajphr-4-4-5

Abstract

Introduction: The transition of patient care to the resident on call during the sign-out/hand off is an integral part of residency training and is a time vulnerable to medical errors. Methods: Authors conducted the study from July 28th to December 14th 2014. Residents (n=26) were required to sign-out via the electronically via the SBAR (Situation-Background-Assessment-Recommendation) based electronic template. The quality of sign-out was assessed by night float questionnaire. The quality of the sign-out (scale 1 to 5), preventable morbidities, LOS, mortalities and readmissions were compared pre and post intervention for the admitted patients (pre= 184, post=172). Results: Improvement in the mean quality (Likert scale 1-5) of both the written sign-out, 3.0 to 3.8 (p<0.001), and verbal sign-out, 3.0 to 3.6 (p=0.002) (n=22 pre and post), was found. The preventable morbidities decreased from 10% to 5% (p=0.047). No statistically significant difference was noted for lethal morbidities, length of stay or readmissions. Conclusion: Implementation of electronic sign-out in addition to verbal sign-out improved the quality of sign-out with trend towards reduction in morbidities. The electronic sign-out may provide key information and help the on call team to make better decisions regarding the patient care.

Keywords:
sign-out transition of care residency training quality improvement performance improvement

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References:

[1]  Wohlauer MV, Arora VM, Horwitz LI, Bass EJ, Mahar SE, Philibert I. The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care. Acad Med 2012;87:411-418.
 
[2]  http://www.acgme.org/What-We-Do/Accreditation/Duty-Hours. The ACGME Duty Hours.
 
[3]  Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med 2006;166:1173-1177.
 
[4]  McCrory MC, Aboumatar H, Custer JW, Yang CP, Hunt EA. “ABC-SBAR” training improves simulated critical patient hand-off by pediatric interns. Pediatr Emerg Care 2012;28:538-543.
 
[5]  Vawdrey DK, Stein DM, Fred MR, Bostwick SB, Stetson PD. Implementation of a computerized patient handoff application. AMIA Annu Symp Proc 2013;2013:1395-1400.
 
[6]  Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC. I-pass, a mnemonic to standardize verbal handoffs. Pediatrics 2012;129: 201-204.
 
[7]  Starmer AJ, Sectish TC, Simon DW et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA 2013;310: 2262-2270.
 
[8]  Starmer AJ, Spector ND, Srivastava R et al. Changes in medical errors after implementation of a handoff program. N Engl J Med 2014; 371:1803-1812.
 
[9]  Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 2006;32:167-175.
 
[10]  www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_07012016.pdf. ACGME Common Program Requirements 2016.
 
[11]  Dekosky AS, Gangopadhyaya A, Chan B, Arora VM. Improving Written Sign-Outs Through Education and Structured Audit: The UPDATED Approach. J Grad Med Educ 2013;5:335-336.
 
[12]  Lee JC, Horst M, Rogers A et al. Checklist-styled daily sign-out rounds improve hospital throughput in a major trauma center. Am Surg 2014;80:434-440.
 
[13]  Oak SN, Dave NM, Garasia MB, Parelkar SV. Surgical checklist application and its impact on patient safety in pediatric surgery. J Postgrad Med 2015;61:92-94.
 
[14]  Agarwal HS, Saville BR, Slayton JM et al. Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational sustainability and improved team performance*. Crit Care Med 2012;40:2109-2115.
 
[15]  Graham KL, Marcantonio ER, Huang GC, Yang J, Davis RB, Smith CC. Effect of a systems intervention on the quality and safety of patient handoffs in an internal medicine residency program. J Gen Intern Med 2013;28:986-993.
 
[16]  Gonzalo JD, Yang JJ, Stuckey HL, Fischer CM, Sanchez LD, Herzig SJ. Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. Int J Qual Health Care 2014;26:337-347.
 
[17]  Inaba K, Recinos G, Teixeira PG et al. Complications and death at the start of the new academic year: is there a July phenomenon? J Trauma 2010;68:19-22.
 
[18]  Shulkin DJ. The July phenomenon revisited: are hospital complications associated with new house staff? Am J Med Qual 1995;10:14-17.
 
[19]  Levy K, Voit J, Gupta A, Petrilli CM, Chopra V. Examining the July Effect: A National Survey of Academic Leaders in Medicine. Am J Med 2016;129:754-755.
 
[20]  Petrilli CM, Del VJ, Chopra V. Why July Matters. Acad Med 2016;91:910-912.
 
[21]  Lied TR, Kazandjian VA. A Hawthorne strategy: implications for performance measurement and improvement. Clin Perform Qual Health Care 1998;6:201-204.