IMOUTA: A proposal for patient care handoffs


  • Matthew P. Connor MD, Captain, USAF-MC,

    Corresponding author
    1. Department of Otolaryngology, San Antonio Military Medical Center, Ft. Sam Houston, Texas, U.S.A
    • Send correspondence to Matthew P. Connor, MD, Captain, USAF-MC Department of Otolaryngology, SSS/SG020, Wilford Hall Medical Center 2200 Bergquist Drive, Suite 100 Lackland AFB, TX 78236-9908. E-mail:

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  • Anneke C. Bush ScD, MHS,

    1. Clinical Investigations Division, Wilford Hall Ambulatory Surgical Center, Lackland, AFB
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  • Joseph Brennan MD, Col, USAF-MC

    1. Department of Surgery, San Antonio Military Medical Center, Ft. Sam Houston, Texas
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  • Presented at the Triological Society Combined Sections Meeting, Scottsdale, AZ, January 25, 2013.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose. The opinions expressed on this document are solely those of the authors and do not represent an endorsement by or the views of the United States Air Force, the Department of Defense, or the United States Government.



An increased frequency of patient handoffs has occurred as a result of the new resident work-hour restrictions that have recently been instituted. Inadequate handoff of patient care has been associated with adverse patient events due to residents being unprepared for events that happen during cross cover periods. The objective of our study was to develop and test the effectiveness of a patient handoff method in an otolaryngology residency program.

Study Design

Single-blinded controlled clinical trial.


A standardized, anonymous questionnaire was developed that scored on-call residents' understanding of their patients' diagnoses, hospital courses, active concerns, and treatment plans. For the first 45 days, residents used their traditional handoff. This handoff was prepared by the residents, relaying relevant patient information without any structured format. For the next 45 days, the residents followed the acronym of IMOUTA for handoffs. This mnemonic was developed to help residents identify data (I), medical course (M), outcomes possible tonight (OU), responsibilities to do tonight (T), and opportunity to ask questions and give morning feedback in the AM (A). The questionnaires were then compared at the end of the study.


The residents who used the IMOUTA acronym scored significantly higher on their perceived knowledge of patients diagnoses (P = 0.001), hospital courses (P <0.001), active concerns (P <0.001), and treatment plans (P <0.001).


Residents felt significantly better prepared for call duties when using the IMOUTA acronym. This standardized system of patient handoff may also be valuable to other residency programs.

Level of Evidence

N/A. Laryngoscope, 123:2649–2653, 2013