Ochsner Clinic Foundation, New Orleans, LA
Implementing a Standardized and Sustainable Resident Sign-Out Process at Ochsner Clinic Foundation: An AIAMC National Initiative IV Project

Abstract

Background: Duty-hour restrictions imposed on training physicians have led to increased patient handoffs and the potential for discontinuity in patient care. We identified a significant need to formalize a process for transitions of care between inpatient settings.

Methods: We distributed surveys to residents and faculty to assess current perceptions and practices surrounding transitions of care. We met with program directors and residents from multiple specialties to review the importance of sign-out standardization and our goals at the institutional level. We designed a written sign-out template, using elements from the pneumonic ANTICipate. We programmed the written document within the EMR, and we piloted it as a standardized and up-to-date sign-out tool accessible via computers and iPads. We defined a verbal sign-out modeled after the pneumonic I-PASS, developed at Boston Children's Hospital. We printed tables for both the written and verbal handoff processes on note cards and distributed them to all staff and residents. We held interactive didactic sessions introducing the documents and training participants in their use. We facilitated feedback and discussion surrounding specialty-specific requirements and considerations for the handoff process. We repeated the survey to quantify improvement; we plan a later survey to evaluate sustainability. We identified stakeholders to ensure sustainability of the project and continued improvement.

Results: Repeat survey results were obtained from 45 faculty members and 63 residents representing multiple specialties. Comparing the initial results to the repeat survey, there remained variability in process perception. Seventy-two percent of faculty reported at least once identifying a patient safety issue occurring as a result of the handoff process consistent with the initial survey results. Faculty reporting supervision of the handoff process increased from 82% to 86%. In the initial survey, 80% of residents reported sometimes or never receiving feedback on their handoffs, and that number decreased to 70% in the repeat survey. The percentage of residents reporting the use of a standardized process for handoffs also increased.

Conclusions: Results indicate a modest increase in feedback with respect to and supervision of handoffs. As we progress with systemwide implementation, we plan to incorporate objective metrics such as numbers of laboratory tests ordered by residents, changes in hospital length of stay, and medication occurrences because these parameters will complement subjective data from observer evaluations and survey results.