Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Leora I. Horwitz

Subject Area(s)

Medicine

Abstract

SIGN-OUT SNAPSHOT: EVALUATION OF WRITTEN SIGN-OUTS AMONG SPECIALTIES AND ROLE OF HOSPITALIST SIGN-OUT.

Amy R. Schoenfeld, Robert L. Fogerty, Mohammed Salim, and Leora I. Horwitz. Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.

In our first study, we compared written sign-out practices across specialties. We hypothesized that most sign-outs would contain key content and be updated within 24 hours, independent of specialty. We evaluated all non-Intensive Care Unit written sign-outs from five specialties on January 18, 2012, at Yale-New Haven Hospital. Our final cohort included 457 sign-outs: 313 medicine, 64 general surgery, 36 pediatrics, 30 obstetrics, and 14 gynecology. Though nearly all sign-outs (96%) had been updated within 24 hours, they often lacked key information. Hospital course prevalence ranged from 57% (gynecology) to 100% (pediatrics) (p<0.001). Clinical condition ranged from 34% (surgery) to 72% (pediatrics) (p=0.005). Thus, structured templates alone do not guarantee inclusion of critical content, and specialties have varied sign-out practices.

In our second study, we surveyed medicine hospitalists in order to assess the role of sign-out. We hypothesized that sign-outs deemed "sufficient" by hospitalists would contain certain content and be updated. Fifteen hospitalists at Yale-New Haven Hospital participated in a survey about inquiries they received overnight. Our final study cohort included 124 inquiries regarding 96 patients, 69 of whom had sign-outs. Chi square analysis found that sufficient sign-outs most often had a composite score of four (denoting inclusion of key content and being updated), and had at least two total anticipatory guidance statements and/or tasks. Hospitalists often use supplemental sources to answer overnight inquiries, suggesting that most sign-outs do not provide sufficient information.

Comments

This is an Open Access Thesis.

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