Sign outs

1. Sign outs • Good communication is essential and critical for appropriate patient care • Difficult to master the technique to include all pertinent information in a concise manner • Process not uniform • More “handoff’s” due to duty hour restrictions

2. Patient Hand Off Tool (HOT) • Used by most services in the hospital for communication and sign out • Prepared by the primary team but can be edited by any service/consultant • Intern nightfloat will have a copy of the HOT on each patient

4. Sign out Process • Should be done in a quiet place with the least number of distractions possible • Start with your sickest patient • Make sure ALL your patients are included!

5. Sign Out Process • S- sick and code status • I- ID statement • G- General hospital course • N- new events • O- overall health status • U- upcoming events/possibilities • T- “to do” overnight

6. Discharge Summaries • Are dictated at UH; typed at VA • Must be done DAY OF DISCHARGE • Tag a day of discharge progress note at end to save you time • Thorough yet not too lengthy!

7. How To Dictate • Dial 66000 in house • Dial (216) 286-6000 from outside • Physician ID # • 1# • 7# • Medical Record Number # • “begin dictation”….

8. How To Dictate • “This is Dr. x dictating discharge summary for patient x MR number xxx” • Date of Admission; Date of Discharge • Attending on service • Discharge Diagnosis • Procedures performed • HPI/Hospital Course • Discharge medications* • Follow up appointments • follow up items • Condition and disposition at discharge • Day of discharge progress note • copies of dictation you want sent • PCP, Consultants

9. How To Dictate • Important Keypad numbers • 5 is pause • 2 is to resume • 9 for confirmation number • Remember to divide paragraphs • Can be amended • Can be done from home

10. Questions