In September we did our Tip of the Week on “”, citing great work done primarily by residents and other housestaff to improve on the handoff process. Now surgical residents at Johns Hopkins (Kemp 2008) have, based on their experiences with inadequate handoffs, put together their “Top 10 List for a Safe and Effective Sign-out”. They stressed providing adequate time and appropriate quiet environment for sign-outs, emphasizing the need for sign-out to be an active 2-way interaction. They want a standardized list/format, including items that are important to surgical patients. Prioritizing the patients (knowing which patients are the sickest and seeing them first) was important, as was knowing who the senior resident on-call was. The sign-out should include outstanding tasks, outstanding lab/radiology studies, outstanding consults, and details about any pending admissions. Morning sign-out is just as important as evening sign-out and adequate time should be provided for this as well.
They have included this list and process in their intern orientation. They even include a simulation sign-out as part of that orientation. They also discuss the utility of web-based patient sign-out lists but note that the sign-out lists, whether paper or electronic, should be destroyed after the on-call period to preserve patient confidentiality.
Kemp CD, Bath JM, Berger J, Bergsman A, Ellison T, Emery K, Garonzik-Wang J, Hui-Chou HG, Mayo SC, Serrano OK, Shridharani S, Zuberi K, Lipsett PA, Freischlag JA. The Top 10 List for a Safe and Effective Sign-out. Arch Surg. 2008;143(10):1008-1010