![]() IPASS - Illness severity, Patient summary, Action list, Situational awareness, Synthesis by receiver. “Giver” of signout should ideally follow a standardized presentation strategy for each patient. However, sign-out is not a time to do an in-depth review on basic topics - lengthy interruptions should be avoided. ![]() Unique learning points for safety may be raised Senior residents sign out should strive to serve as a role model for junior team members to demonstrate communication style, active listening, and prioritization.Īt the same time, sign out should be recognized as a patient safety event and treated the same: Senior residents and attendings should role model effective communication and elicit team member concerns. I.e.,A student, first year resident, or RN should all be as comfortable to communicate in sign out as the senior resident or attending regarding a concern. These hierarchies may lead to communication challenges in patient care: Many times in OB/GYN residency, sign out is predicated on a structural hierarchy.Ĭertainly, all patients should have a primary individual or team responsible for them, but a back-up system should be in place in case the primary contact is unavailable. Standardized terminology allows for conveyance of the appropriate message and plan of care colloquialisms may leave significant room for error due to being inexact.Īlso consider language importance with respect to professional communication - attention to terms that may be culturally or personally insensitive, or the use of judgment statements rather than objective facts. Try to stick to understood medical language: i.e., “Category II for repetitive variable decelerations” instead of “this baby’s been a little naughty.” This requires redundancy in those who are aware of patients on the service - sign out is a team responsibility, not an individual one! Sufficient time should be set aside to protect effective handoff.Ĭonsider assigning someone specifically to address acute patient concerns during sign out - this keeps a significant amount of the team intact to focus on information exchange. Paper forms for hand-off should be legible and organized.įortunately many EMRs are incorporating sign-out templates, but don’t be afraid to ask your institution to modify things if needed to apply to your environment. “Warm hand off” in a patient room as appropriate for particularly significant cases. Quiet, and ideally away from distractions i.e., a quiet conference room vs at nursing station.Īreas where patient confidentiality is preserved. The environment should be set appropriately. Identify any tasks or specific guidance for the receiving team to complete.Ĭonsider organizing sign out order by acuity/urgency or timely completion of these tasks. Reviewing daily updates to ensure most salient points are reviewed during verbal discussion. Updating any signout template or process used at your institution. The “giver” of signout should organize and update information to be prepared for handoff. Three primary focuses to improve sign out:īeing a good (and thorough) “giver” of sign out.īeing a good (and vigilant) “receiver” of sign out. Interpersonal characteristics (defensiveness, minimizing, conflict-averse or conflict-prone)Ĭommunication errors are frequently identified as pain points or root causes of safety events. Internal dynamics (power differential, hierarchy, fatigue) Patient care transitions represent a potential challenge to all of us:Ĭommunication is challenging - different styles and preferencesĮxternal dynamics (interruptions, emergencies, home-life demands) Sign out or hand off – transferring of patient knowledge and plan between two physicians or care teams. Read on with ACOG Committee Opinion: Sign Out
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