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Development of a structured year-end sign-out program in an outpatient continuity practice.
Ann R Garment1, Wei Wei Lee, Christina Harris
1Division of General Internal Medicine, New York University-Langone Medical Center, New York, NY, USA.
Journal of General Internal Medicine
|September 20, 2012
Summary
A structured outpatient sign-out program significantly improved the completion of patient care tasks during resident transitions. This structured approach enhances patient safety in ambulatory settings.
Area of Science:
- Medical Education
- Patient Safety
- Health Systems Research
Background:
- Standardized communication during care transitions is recommended to prevent medical errors.
- Most research focuses on inpatient transitions, with limited data from outpatient settings.
Purpose of the Study:
- To develop and evaluate a structured transfer of care program in an academic outpatient continuity practice.
- To assess if the program improved patient safety by measuring the completion of care tasks 3 months post-transition.
Main Methods:
- Randomized controlled trial involving graduating residents and incoming interns in an internal medicine residency program.
- Structured transfer group received written and verbal sign-outs; standard group followed the existing process.
- Patient care task completion, follow-up appointments, continuity of care, and house officer satisfaction were evaluated at 3 months.
Main Results:
- Clinical care tasks were more likely completed in the structured group (73%) versus the standard group (46%).
- Completion rates were further enhanced when the intern seeing the patient was also the assigned primary care provider.
- The structured approach significantly improved the odds of task completion (adjusted OR 3.21).
Conclusions:
- A structured outpatient sign-out process enhances the follow-up of critical clinical care tasks during resident transitions.
- Further development is needed to improve resident competency in ambulatory care sign-outs.
- Structured sign-outs represent a key strategy for improving patient safety in outpatient continuity practices.
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