@article {Horwitz248, author = {L I Horwitz and T Moin and H M Krumholz and L Wang and E H Bradley}, title = {What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff}, volume = {18}, number = {4}, pages = {248--255}, year = {2009}, doi = {10.1136/qshc.2008.028654}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objectives: To characterise and assess sign-out practices among internal medicine house staff, and to identify contributing factors to sign-out quality.Design: Prospective audiotape study.Setting: Medical wards of an acute teaching hospital.Participants: Eight internal medicine house staff teams.Measurements: Quantitative and qualitative assessments of sign-out content, clarity of language, environment, and factors affecting quality and comprehensiveness of oral sign-out.Results: Sign-out sessions (nā€Š=ā€Š88) contained 503 patient sign-outs. Complete written sign-outs accompanying 50/88 sign-out sessions (57\%) were collected. The median duration of sign-out was 35 s (IQR 19{\textendash}62) per patient. The combined oral and written sign-outs described clinical condition, hospital course and whether or not there was a task to be completed for 184/298 (62\%) of patients. The least commonly conveyed was the patient{\textquoteright}s current clinical condition, described in 249/503 (50\%) of oral sign-outs and 117/306 (38\%) of written sign-outs. Most patient sign-outs (298/503, 59\%) included no questions from the sign-out recipient (median 0, IQR 0{\textendash}1). Five factors were associated with a higher rate of oral content inclusion: familiarity with the patient, sense of responsibility for the patient, only one sign-out per day, presence of a senior resident and a comprehensive written sign-out. Omissions and mischaracterisations of data were present in 22\% of sign-outs repeated in a single day.Conclusions: Sign-outs are not uniformly comprehensive and include few questions. The findings suggest that several changes may be required to improve sign-out quality, including standardising key content, minimising sign-outs that do not involve the primary team, templating written sign-outs, emphasising the role of sign-out in maintaining patient safety and fostering a sense of direct responsibility for patients among covering staff.}, issn = {1475-3898}, URL = {https://qualitysafety.bmj.com/content/18/4/248}, eprint = {https://qualitysafety.bmj.com/content/18/4/248.full.pdf}, journal = {BMJ Quality \& Safety} }