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Related Concept Videos

Methods of Documentation II: POMR01:26

Methods of Documentation II: POMR

The Problem-Oriented Medical Record (POMR) revolutionized medical record-keeping by introducing a systematic approach focusing on the patient's problems rather than merely listing symptoms. Dr. Lawrence Weed's introduction of this method in the 1960s marked a significant advancement in medical documentation. The POMR framework consists of four key components: the database, problem list, plan of care, and progress notes.
SBAR I: Understanding the Concept01:29

SBAR I: Understanding the Concept

Effective communication among healthcare professionals during hand-off reporting is essential to delivering safe and continuous patient care. Common professional interactions include reports to healthcare team members, hand-off, and transfer reports. Nurses routinely report information to other healthcare team members and also urgently contact healthcare providers to report changes in patient status.
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Guidelines and Strategies for Safe Computer Charting

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Discharge Summary Forms01:31

Discharge Summary Forms

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Types of Reports I: Hand-off Report01:25

Types of Reports I: Hand-off Report

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Noncompartmental Analysis: Mean Residence Time01:05

Noncompartmental Analysis: Mean Residence Time

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Related Experiment Video

Updated: Jun 13, 2026

Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments
08:36

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Published on: August 8, 2019

Dedicated Shift Wrap-up Time Does Not Improve Resident Sign-out Volume or Efficiency.

Rebecca K Jeanmonod1, Christopher Brook, Mark Winther

  • 1St. Luke's Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA.

The Western Journal of Emergency Medicine
|April 23, 2010
PubMed
Summary

Implementing a 9-hour shift with dedicated wrap-up time for emergency medicine residents did not reduce sign-out (SO) burden. The percentage of patients signed out remained constant regardless of shift length, indicating no impact on SO workload.

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Area of Science:

  • Emergency Medicine
  • Medical Education
  • Healthcare Operations

Background:

  • Sign-out (SO) processes in emergency medicine are a known challenge for physicians.
  • Some training programs utilize overlapping 9-hour shifts with a dedicated hour for patient care wrap-up.
  • This strategy aims to reduce the number of patients requiring sign-out at the end of a shift.

Purpose of the Study:

  • To evaluate the impact of 9-hour shifts with a wrap-up hour on the sign-out burden for emergency medicine residents.
  • To compare sign-out burden and patient turnaround time (TAT) between 9-hour and 12-hour shifts.

Main Methods:

  • Retrospective review of patient data from emergency medicine residents on 9-hour and 12-hour shifts.
  • Data collected from clinical trackers, defining sign-out as any patient without disposition at shift change.
  • Analysis included patient turn-around-time (TAT) and the percentage of patients signed out per resident class.

Main Results:

  • Shift length did not significantly alter sign-out burden when controlling for patients seen per hour.
  • Postgraduate-year-two (PGY2) and postgraduate-year-three (PGY3) residents showed similar sign-out burdens across shift types.
  • Postgraduate-year-three (PGY3) residents had a significantly faster patient TAT (175 minutes) compared to PGY1 (189 minutes) and PGY2 (187 minutes).

Conclusions:

  • An additional hour for patient care wrap-up does not reduce the overall sign-out burden for emergency medicine residents.
  • Sign-out burden appears to be a fixed percentage of total patients seen, irrespective of shift structure.
  • PGY3 residents demonstrate greater efficiency, signing out a smaller percentage of patients and achieving faster TATs.