TY - JOUR T1 - What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff JF - Quality and Safety in Health Care JO - Qual Saf Health Care SP - 248 LP - 255 DO - 10.1136/qshc.2008.028654 VL - 18 IS - 4 AU - L I Horwitz AU - T Moin AU - H M Krumholz AU - L Wang AU - E H Bradley Y1 - 2009/08/01 UR - http://qualitysafety.bmj.com/content/18/4/248.abstract N2 - 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 (n = 88) 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 19–62) 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’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 0–1). 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. ER -