Transforming Hospital Care
Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-out
Article first published online: 10 AUG 2006
Copyright © 2006 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 1, Issue 4, pages 257–266, July/August 2006
How to Cite
Vidyarthi, A. R., Arora, V., Schnipper, J. L., Wall, S. D. and Wachter, R. M. (2006), Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-out. J. Hosp. Med., 1: 257–266. doi: 10.1002/jhm.103
- Issue published online: 10 AUG 2006
- Article first published online: 10 AUG 2006
- Manuscript Accepted: 25 APR 2006
- Manuscript Revised: 21 APR 2006
- Manuscript Received: 24 FEB 2006
- systems of care;
- medical education;
- patient safety
Restrictions in the hours residents can be on duty have resulted in increased sign-outs, that is, transfer of patient care information and responsibility from one physician to a cross-coverage physician, leading to discontinuity in patient care. This sign-out process, which occurs primarily in the inpatient setting, traditionally has been informal, unstructured, and idiosyncratic. Although studies show that discontinuity may be harmful to patients, this is little data to assist residency programs in redesigning systems to improve sign-out and manage the discontinuity.
This article reviews the relevant medical literature, current practices in non–health professions in managing discontinuity, and summarizes the existing practice and experiences at 3 academic internal medicine hospitalist-based programs.
We provide recommendations and strategies for best practices to design safe and effective sign-out systems for residents that may also be useful to hospitalists working in academic and community settings. Journal of Hospital Medicine 2006;1:257–266. © 2006 Society of Hospital Medicine.