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PATIENT SIGN-OUT COMMUNICATION FAILURES

The transfer of care for hospitalised patients routinely uses written and verbal communication (“sign-outs” or “hand-overs”). This study of resident trainees in a teaching hospital describes how communication failures during this process can affect patient care. Omitted content (eg medications, active problems, and pending tests) or failure prone communication processes (eg lack of face-to-face discussion) emerged as major categories of failed communication. In nearly all cases these failures led to uncertainty during patient–care decisions, which at times resulted in suboptimal care. Junior doctors preferred thorough but relevant face-to-face verbal sign-outs that reviewed anticipated issues, together with legible, accurate, updated written sign-out sheets that included standard patient content, such as code status or active and anticipated medical problems. These authors provide a taxonomy of communication failures and potential improvements, which may improve the quality and safety of patient care.
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