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Dr. William H. Morris Director Clinical Informatics. Staff, Department of Hospital Medicine. Effective Sign-Out for Safety and Continuity of Care. Learning Objectives. Define Signout: What it is and what it is NOT
Effective Sign-Out for Safety and Continuity of Care
Define Signout: What it is and what it is NOT
Identify regulatory and patient safety factors of implementing a Signout process
Identify key workflow and tool opportunities for an effective tool
Joint Commission: Issue 26 - June 17, 2002
Delays in treatment
Average number of patient sign-outs per month for a single resident: 300
Estimated total number of patient sign-outs per day (including all health care providers) in large academic hospital: 4,000
Estimated total number of patient sign-outs per year in a hospital: 1.6 million
Why is it important to perfect?
Arpana Vidyarthi MD; derived from MDHCUPnet, Healthcare Cost and Utilization Project.
Residency training requirement
Physician Assistants and Nurse Practitioners
ACGME Executive Committee Approved February 14, 2005
National Patient Safety Goal: NPSG 02.05.01
The hospital implements a standardized approach to hand-off communications, including an opportunity to ask and respond to questions
Leadership Standard: LS.03.04.01
“Effective communication is essential among individuals and groups within the hospital…”
Medical Staff Standard: MS.05.01.03
“The organized medical staff participates in coordination of care, treatment and services with other practitioners and hospital personnel, as relevant to the care, treatment and services of an individual patient…”
“The hospital must coordinate the care, treatment and services provided to a patient. In order to provide continuity of care, it should have an established method of communication between inpatient services and outpatient care in order to provide continuity of care to its patients.”
Joint Commission Requirements
Using paper, email, or spreadsheet to record the information….
..information is tied up, and NOT easily accessible to future providers
Using the Continuity of Care tool
The accepting physician enters clinical data and important bed placement information
Bed Utilization: Unit request
Confirmation by Bed utilization
Ms. Smith arrives, the system alerts the user that the patient is registered with ADT.
Using unique patient identifiers, the system looks for matches within patients on the “to come in” list and those admitted.
The system prompts the user to reconcile those matches.
The floor nurse reads the sign-out, and contacts the correct admitting attending.
The admitting attending can access all the clinical history obtained by the accepting physician hours before.
The system will provide for updates to EHR and ADT systems for treatment teams
Clinical history obtained by the accepting physician hours earlier
Drive the clinical plan as soon as patient arrives
1 patient, all signouts
Continuity of Care