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Effectiveness of written hospitalist sign-outs in answering overnight inquiries

Authors

  • Robert L. Fogerty MD, MPH,

    Corresponding author
    1. Section of General Internal Medicine, Yale University School of Medicine, and Yale–New Haven Hospital Hospitalist Service, Yale–New Haven Hospital, New Haven, Connecticut
    • Address for correspondence and reprint requests: Robert L. Fogerty, MD, Yale University School of Medicine, P.O. Box 208093, New Haven, CT 06520–8093; Telephone: 203-688-4748; Fax: 203–737-3306; E-mail: robert.fogerty@yale.edu

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  • Amy Schoenfeld MD,

    1. Massachusetts General Hospital, Boston, Massachusetts
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  • Mohammed Salim Al-Damluji MD, MPH,

    1. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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  • Leora I. Horwitz MD, MHS

    1. Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, and the Center for Outcomes Research and Evaluation, Yale–New Haven Health System, New Haven, Connecticut
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Abstract

BACKGROUND

Hospitalists are key providers of care to medical inpatients, and sign-out is an integral part of providing safe, high-quality inpatient care. There is little known about hospitalist-to-hospitalist sign-out.

OBJECTIVE

To evaluate the quality of hospitalist/physician-extender sign-outs by assessing how well the sign-out prepares the night team for overnight events and to determine attributes of effective sign-out.

DESIGN

Analysis of a written-only sign-out protocol on a nonteaching hospitalist service using prospective data collected by an attending physician survey during overnight shifts.

SETTING

Yale–New Haven Hospital, a 966-bed, urban, academic medical center in New Haven, Connecticut with approximately 13,700 hospitalist discharges annually.

RESULTS

We recorded 124 inquiries about 96 patients during 6 days of data collection in 2012. Hospitalists referenced the sign-out for 89 (74%) inquiries, and the sign-out was considered sufficient in isolation to respond to 27 (30%) of these inquiries. Hospitalists physically saw the patient for 14 (12%) of inquiries. Nurses were the originator for most inquiries (102 [82%]). The most common inquiry topics were medications (55 [45%]), plan of care (26 [21%]), and clinical changes (26 [21%]). Ninety-five (77%) inquiries were considered to be “somewhat” or “very” clinically important by the hospitalist.

CONCLUSIONS

Overall, we found that attending hospitalists rely heavily on written sign-out to address overnight inquiries, but that those sign-outs are not reliably effective. Future work to better understand the roles of written and verbal components in sign-out is needed to help improve the safety of overnight care. Journal of Hospital Medicine 2013;8:609–614. © 2013 Society of Hospital Medicine

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