Journal of General Internal Medicine

, Volume 22, Issue 10, pp 1470–1474 | Cite as

Development and Implementation of an Oral Sign-out Skills Curriculum

  • Leora I. Horwitz
  • Tannaz Moin
  • Michael L. Green
Innovations in Education

Abstract

Introduction

Imperfect sign-out of patient information between providers has been shown to contribute to medical error, but there are no standardized curricula to teach sign-out skills. At our institution, we identified several deficiencies in skills and a lack of any existing training.

Aim

To develop a sign-out curriculum for medical house staff. Setting: Internal medicine residency program.

Program description

We developed a 1-h curriculum and implemented it in August of 2006 at three hospital sites. Teaching strategies included facilitated discussion, modeling, and observed individual practice with feedback. We emphasized interactive communication, a structured sign-out format summarized by an easy-to-remember mnemonic (“SIGNOUT”), consistent inclusion of key content items such as anticipatory guidance, and use of concrete language.

Program evaluation

We received 34 evaluations. The mean score for the course was 4.44 ± 0.61 on a 1–5 scale. Perceived usefulness of the structured oral communication format was 4.46 ± 0.78. Participants rated their comfort with providing oral sign-out significantly higher after the session than before (3.27 ± 1.0 before vs. 3.94 ± 0.90 after; p < .001).

Discussion

We developed an oral sign-out curriculum that was brief, structured, and well received by participants. Further study is necessary to determine the long-term impact of the curriculum.

KEY WORDS

medical student and residency education communication skills curriculum development/evaluation 

Notes

Acknowledgements

Dr. Horwitz was supported by the Department of Veterans Affairs at the time this study was conducted. We thank Cyrus Kapadia, M.D., and Stephen J. Huot, M.D., Ph.D., directors of the categorical and primary care Internal Medicine residency programs, respectively, for their cooperation in implementing this curriculum. We also thank chief residents Francis W. Chan, M.D.; Caleb Moore, M.D.; Juliette Spelman, M.D.; and Matthew Stopper, M.D., for their assistance during the small-group sessions.

Conflict of Interest

None disclosed.

References

  1. 1.
    Joint Commission on Accreditation of Healthcare Organizations. Root Causes of Sentinel Events. http://www.jointcommission.org/SentinelEvents/Statistics/. Accessed January 20, 2007.
  2. 2.
    Jagsi R, Kitch BT, Weinstein DF, Campbell EG, Hutter M, Weissman JS. Residents report on adverse events and their causes. Arch Intern Med. 2005;165:2607–13.PubMedCrossRefGoogle Scholar
  3. 3.
    Lofgren RP, Gottlieb D, Williams RA, Rich EC. Post-call transfer of resident responsibility: its effect on patient care. J Gen Intern Med. 1990;5:501–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121:866–72.PubMedGoogle Scholar
  6. 6.
    Beach C. Lost in Transition. AHRQ WebM&M (serial online), February, 2006. http://webmm.ahrq.gov/case.aspx?caseID=116. Accessed January 20, 2007.
  7. 7.
    Beach C, Croskerry P, Shapiro M. Profiles in patient safety: emergency care transitions. Acad Emerg Med. 2003;10:364–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Chassin MR, Becher EC. The wrong patient. Ann Intern Med. 2002;136:826–33.PubMedGoogle Scholar
  9. 9.
    Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005;142:352–8.PubMedGoogle Scholar
  10. 10.
    Mukherjee S. A precarious exchange. N Engl J Med. 2004;351:1822–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Vidyarthi A. Fumbled Handoff. March, 2004. http://webmm.ahrq.gov/case.aspx?caseID=55. Accessed January 20, 2006.
  12. 12.
    Joint Commission on Accreditation of Healthcare Organizations. 2006 Critical Access Hospital and Hospital National Patient Safety Goals. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/06_npsg_cah.htm). Accessed October 8, 2005.
  13. 13.
    Accreditation Council for Graduate Medical Education. Advancing Education in Interpersonal and Communication Skills: An educational resource from the ACGME Outcome Project. http://www.acgme.org/outcome/implement/interperComSkills.pdf. Accessed January 20, 2007.
  14. 14.
    Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 2006;166:1173–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Sinha M, Shriki J, Salness R, Blackburn PA. Need for standardized sign-out in the emergency department: a survey of emergency medicine residency and pediatric emergency medicine fellowship program directors. Acad Emerg Med. 2006.Google Scholar
  16. 16.
    Joint Commission on Accreditation of Healthcare Organizations. Patient Safety Practices related to Patient Safety Goal 2E. http://www.jcipatientsafety.org/22791/). Accessed January 20, 2007.
  17. 17.
    British Medical Association, National Patient Safety Agency, NHS Modernisation Agency. Safe Handover: Safe Patients. London: British Medical Association; 2004.Google Scholar
  18. 18.
    University HealthSystem Consortium. UHC Best Practice Recommendation: Patient Hand Off Communication: White Paper. Oak Brook, IL: UHC; 2006.Google Scholar
  19. 19.
    Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum Development for Medical Education: A Six-Step Approach. Baltimore, MD: The Johns Hopkins University Press; 1998.Google Scholar
  20. 20.
    Institute of Education Sciences. Education Resources Information Center. http://www.eric.ed.gov/ERICWebPortal/Home.portal. Accessed January 20, 2007.
  21. 21.
    American Association of Medical Colleges. AAMC Curriculum Management and Information Tool (CurrMIT©). http://services.aamc.org/currdir/start.cfm). Accessed January 20, 2007.
  22. 22.
    American Association of Medical Colleges. MedEdPORTAL: Providing Online Resources to Advanced Learning in Medical Education. http://services.aamc.org/jsp/mededportal/goLinkPage.do?link=home). Accessed January 20, 2007.
  23. 23.
    Alliance for Academic Internal Medicine. Educational Tools: Curricula. http://www.im.org/AAIM/Tools/Curricula.htm). Accessed January 20, 2007.
  24. 24.
    Council on Medical Student Education in Pediatrics. APA/COMSEP General Pediatric Clerkship Curriculum. http://www.comsep.org/Curriculum/). Accessed January 20, 2007.
  25. 25.
    Josiah Macy Jr. Foundation. http://www.josiahmacyfoundation.org/). Accessed January 20, 2007.
  26. 26.
    Thomas PA, Kern DE. Internet resources for curriculum development in medical education: an annotated bibliography. J Gen Intern Med. 2004;19:599–605.PubMedCrossRefGoogle Scholar
  27. 27.
    Green ML. Identifying, appraising, and implementing medical education curricula: a guide for medical educators. Ann Intern Med. 2001;135:889–96.PubMedGoogle Scholar
  28. 28.
    Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14:401–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Hanna D, Griswold P, Leape LL, Bates DW. Communicating critical test results: safe practice recommendations. Jt Comm J Qual Patient Saf. 2005;31:68–80.PubMedGoogle Scholar
  30. 30.
    Lee LH, Levine JA, Schultz HJ. Utility of a standardized sign-out card for new medical interns. J Gen Intern Med. 1996;11:753–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Marill KA, Gauharou ES, Nelson BK, Peterson MA, Curtis RL, Gonzalez MR. Prospective, randomized trial of template-assisted versus undirected written recording of physician records in the emergency department. Ann Emerg Med. 1999;33:500–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Parker J, Coiera E. Improving clinical communication: a view from psychology. J Am Med Inform Assoc. 2000;7:453–61.PubMedGoogle Scholar
  33. 33.
    Petersen LA, Orav EJ, Teich JM, ONeil AC, Brennan TA. Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv. 1998;24:77–87.PubMedGoogle Scholar
  34. 34.
    Ram R, Block B. Signing out patients for off-hours coverage: comparison of manual and computer-aided methods. Proc Annu Symp Comput Appl Med Care. 1992:114–8.Google Scholar
  35. 35.
    Van Eaton EG, Horvath KD, Lober WB, Rossini AJ, Pellegrini CA. A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. J Am Coll Surg. 2005;200:538–45.PubMedCrossRefGoogle Scholar
  36. 36.
    Vidyarthi AR, Arora V, Schnipper JL, Wall SD, Wachter RM. Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-out. J Hosp Med. 2006;1:257–266.PubMedCrossRefGoogle Scholar
  37. 37.
    Helmreich RL. On error management: lessons from aviation. BMJ. 2000;320:781–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Burke CS, Salas E, Wilson-Donnelly K, Priest H. How to turn a team of experts into an expert medical team: guidance from the aviation and military communities. Qual Saf Health Care. 2004;13(Suppl 1):i96–i104.PubMedCrossRefGoogle Scholar
  39. 39.
    Carvalho PV, Dos Santos IL, Vidal MC. Safety implications of cultural and cognitive issues in nuclear power plant operation. Appl Ergon. 2006;37:211–23.PubMedCrossRefGoogle Scholar
  40. 40.
    Patterson ES, Roth EM, Woods DD, Chow R, Gomes JO. Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual Health Care. 2004;16:125–32.PubMedCrossRefGoogle Scholar
  41. 41.
    Patterson ES, Woods DD. Shift changes, updates, and the on-call architecture in space shuttle mission control. Comput Support Coop Work. 2001;10:317–46.PubMedCrossRefGoogle Scholar
  42. 42.
    National Coordinating Council for Medication Error Reporting and Prevention. Recommendations to Reduce Medication Errors Associated with Verbal Medication Orders and Prescriptions: Adopted February 20, 2001. http://www.nccmerp.org/council/council2001-02-20.html). Accessed January 20, 2007.
  43. 43.
    Volpp KG, Grande D. Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med. 2003;348:851–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf. 2006;32:167–75.PubMedGoogle Scholar
  45. 45.
    Howard GS, Dailey PR. Response-shift bias: A source of contamination of self-report measures. J Appl Psychol. 1979;64:144–50.CrossRefGoogle Scholar
  46. 46.
    Skeff KM, Stratos GA, Bergen MR. Evaluation of a medical faculty development program: a comparison of traditional pre/post and retrospective pre/post self-assessment ratings. Eval Health Prof. 1992;15:350–66.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Leora I. Horwitz
    • 1
    • 2
  • Tannaz Moin
    • 2
  • Michael L. Green
    • 2
  1. 1.Center for Outcomes Research and EvaluationYale-New Haven HospitalNew HavenUSA
  2. 2.Department of Internal MedicineYale University School of MedicineNew HavenUSA

Personalised recommendations