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Sign-out snapshot: cross-sectional evaluation of written sign-outs among specialties
  1. Amy R Schoenfeld1,
  2. Mohammed Salim Al-Damluji2,
  3. Leora I Horwitz2,3
  1. 1Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
  3. 3Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
  1. Correspondence to Dr Leora Horwitz, Department of General Internal Medicine, Yale School of Medicine, PO Box 208093, 367 Cedar Street, New Haven, CT 06520-8093, USA; leora.horwitz{at}


Background Sign-out is the process (written, verbal or both) by which one clinical team transmits information about patients to another team. Poor quality sign-outs are associated with adverse events and delayed treatment. How different specialties approach written sign-outs is unknown.

Objective To compare written sign-out practices across specialties and to determine consistency of content, format and timeliness.

Methods The authors evaluated all non-Intensive Care Unit written sign-outs from five inpatient specialties on 18 January 2012, at Yale-New Haven Hospital, focusing on content elements, format style and whether the sign-outs had been updated within 24 h. In our institution, all specialties used a single standardised sign-out template, which was built into the electronic medical record.

Results The final cohort included 457 sign-outs: 313 medicine, 64 general surgery, 36 paediatrics, 30 obstetrics, and 14 gynaecology. Though nearly all sign-outs (96%) had been updated within 24 h, they frequently lacked key information. Hospital course prevalence ranged from 57% (gynaecology) to 100% (paediatrics) (p<0.001). Clinical condition prevalence ranged from 34% (surgery) to 72% (paediatrics) (p=0.005).

Conclusions Specialties have varied sign-out practices, and thus structured templates alone do not guarantee inclusion of critical content. Sign-outs across specialties often lacked complex clinical information such as clinical condition, anticipatory guidance and overnight tasks.

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