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Controlled trial to improve resident sign-out in a medical intensive care unit
  1. Rahul Nanchal1,
  2. Brian Aebly1,
  3. Gabrielle Graves1,
  4. Jonathon Truwit1,2,
  5. Gagan Kumar3,
  6. Amit Taneja1,
  7. Gaurav Dagar1,
  8. Jeanette Graf1,
  9. Erin Hubertz1,
  10. Vijaya Ramalingam1,
  11. Kathlyn E Fletcher1,4
  1. 1 Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  2. 2 Froedtert Health, Milwaukee, Wisconsin, USA
  3. 3 Department of Critical Care, Phoebe Putney Health System, Northeast Georgia Health System Inc, Albany, Georgia, USA
  4. 4 Department of Internal Medicine, Clement J Zablocki VAMC, Milwaukee, Wisconsin, USA
  1. Correspondence to Dr Rahul Nanchal, Medical College of Wisconsin, Department of medicine, 9200 West Wisconsin Ave, Suite E 5200, Milwaukee, Wisconsin, USA; rnanchal{at}


Objective Poor sign-out or handover of care may lead to preventable patient harm. Critically ill patients in intensive care units (ICU) are complex and prone to rapid clinical deterioration. If clinical deterioration occurs, timeliness of appropriate interventions is essential to prevent or reduce adverse outcomes. Therefore sign-outs need to efficiently transmit key information and provide anticipatory guidance. Interventions to improve resident-to-resident ICU sign-outs have not been well described. We conducted a controlled trial to test the effectiveness of a standardised ICU sign-out process to the usual ICU sign-out.

Design Prospective controlled trial.

Setting A 26-bed medical intensive care unit (MICU) in an urban tertiary academic medical centre.

Subjects Residents rotating through the MICU.

Interventions ICU-specific written sign-out template.

Methods Residents completed postcall surveys assessing satisfaction with verbal and written sign-outs and incidence of non-routine events. Our main outcome of interest was the occurrence of non-routine events.

Main results Compared with the intervention group, on significantly more nights, night float residents in the control group encountered patients who were sicker than sign-out would have suggested (15.94% vs 43.75%; p<0.0001). On significantly fewer nights, night float residents in the intervention group indicated that either something happened to patients that was unexpected (18.84% vs 36.51%; p=0.023) or they were insufficiently prepared for (4.35% vs 35.94%; p<0.0001). Similarly, on fewer nights, residents in the intervention group indicated that they had to perform interventions that were unplanned or unanticipated (15.9% vs 37.7%; p=0.005).

Conclusion A structured sign-out process compared with usual sign-out significantly reduced the occurrence of non-routine events in an academic MICU.

  • handoffs
  • non-routine events
  • critical care
  • communication
  • patient safety
  • medical errors
  • preventable adverse events

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  • Competing interests None declared.

  • Ethics approval Medical College of Wisconsin Institutional Review Board (IRB).

  • Provenance and peer review Not commissioned; externally peer reviewed.