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September 04, 2012; 79 (10) Contemporary Issues in Neurologic Practice: Education

Standardized sign-out improves completeness and perceived accuracy of inpatient neurology handoffs

Brian D. Moseley, Jonathan H. Smith, Gloria E. Diaz-Medina, M. Mateo Paz Soldan, Meredith Wicklund, Radhika Dhamija, Haatem Reda, Michael F. Presti, Jeffrey W. Britton
First published August 8, 2012, DOI: https://doi.org/10.1212/WNL.0b013e318265a698
Brian D. Moseley
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Jonathan H. Smith
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Gloria E. Diaz-Medina
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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M. Mateo Paz Soldan
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Meredith Wicklund
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Radhika Dhamija
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Haatem Reda
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Michael F. Presti
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Jeffrey W. Britton
From the Division of Child and Adolescent Neurology (G.E.D.-M., R.D.) and Division of Epilepsy (J.W.B.), Department of Neurology (B.D.M., J.H.S., M.M.P.S., M.W., H.R., M.F.P.), Mayo Clinic, Rochester, MN.
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Citation
Standardized sign-out improves completeness and perceived accuracy of inpatient neurology handoffs
Brian D. Moseley, Jonathan H. Smith, Gloria E. Diaz-Medina, M. Mateo Paz Soldan, Meredith Wicklund, Radhika Dhamija, Haatem Reda, Michael F. Presti, Jeffrey W. Britton
Neurology Sep 2012, 79 (10) 1060-1064; DOI: 10.1212/WNL.0b013e318265a698

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Abstract

Objectives: As residency programs adjust to new duty hour restrictions, the use of cross-coverage systems requiring handoffs will rise. Handoffs are vulnerable to communication failures when unstructured. Accordingly, we implemented a standardized sign-out process on our inpatient neurology services and assessed its effect on completeness and perceived accuracy of handoffs.

Methods: Residents spent the first half of their rotations utilizing unstructured sign-out. They transitioned to a structured sign-out system (using the situation-background-assessment-recommendation format) during the second half of their rotations. We analyzed survey responses before and after implementation to evaluate for an effect.

Results: Residents utilizing structured sign-out were significantly more likely to share test results with patients/families prior to shift changes (p = 0.037), update our electronic service list (p = 0.045), and feel all important data were being transmitted (p = 0.041). Overall satisfaction (scale 1–10) increased from 6.2 ± 1.6 to 7.4 ± 1.3 (p = 0.002).

Conclusions: Our findings demonstrate that standardized sign-out improves the completeness and perceived accuracy of handoffs. Such improvement has the potential to improve patient safety and quality of care.

GLOSSARY

PGY=
postgraduate year

Footnotes

  • Editorial, page 967

  • Received December 4, 2011.
  • Accepted February 1, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.
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