• S M Borowitz, L A Waggoner-Fountain, E J Bass, and R M Sledd.
• Division of Pediatric Gastroenterology and Nutrition, University of Virginia, Charlottesville, Virginia 22908, USA. Witz@virginia.edu
• Qual Saf Health Care. 2008 Feb 1;17(1):6-10.

BackgroundDuring sign-out (handover of care), information and responsibility about patients is transferred from one set of caregivers to another. Few residency training programmes formally teach resident physicians how to sign out or assess their ability to sign out, and little research has examined the sign-out process.ObjectiveTo characterise the effectiveness of the sign-out process between resident physicians on an acute care ward. Design/MethodsResident physicians rotating on a paediatric acute care ward participated in a prospective study. Immediately after an on-call night, they completed a confidential survey characterising their night on call, the adequacy of the sign-out they received, and where they went to get information they had not received during sign-out.Results158 of 196 (81%) potential surveys were collected. On 49/158 surveys (31%), residents indicated something happened while on call they were not adequately prepared for. In 40/49 instances residents did not receive information during sign-out that would have been helpful, and in 33/40 the situation could have been anticipated and discussed during sign-out. The quality of sign-out (assessed using a five-point Likert scale from 1 = inadequate to answer call questions to 5 = adequate to answer call questions) on the nights when something happened the resident was not adequately prepared for were significantly different than the nights they felt adequately prepared (mean (SD) score 3.58 (0.92) and 4.48 (0.70); p = 0.001). There were no significant differences in: how busy the nights were; numbers of patients on service at the beginning of the call shift; numbers of admissions during a call shift; numbers of transfers to an intensive care unit; whether residents were "cross-covering" or were members of the general ward team; or whether the resident had cared for the patient previously.ConclusionAlthough sign-out between resident physicians is a frequent activity, there are many times when important information is not transmitted. Analysis of these "missed opportunities" can be used to help develop an educational programme for resident physicians on how to sign out more effectively.

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