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Feedback to achieve improved sign-out technique.

Matthew E Doers1, Poonam Beniwal-Patel2, Jessica Kuester3

  • 1Medical College of Wisconsin, Milwaukee, WI.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|June 1, 2014
PubMed
Summary

A quality improvement intervention significantly enhanced internal medicine residency sign-out documents. Regular feedback improved key documentation elements and reduced vague language, boosting overall quality.

Keywords:
care transitionscontinuity of caremedical education-communication skillsmedical student and residency educationpatient safety

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Area of Science:

  • Medical Education
  • Quality Improvement
  • Internal Medicine

Background:

  • Effective patient sign-out is crucial for safe patient care transitions.
  • Current sign-out practices in internal medicine residency programs often lack critical information.
  • Standardized tools and feedback mechanisms are needed to improve documentation quality.

Purpose of the Study:

  • To implement and evaluate a quality improvement intervention aimed at enhancing the quality of written sign-out documents in an internal medicine residency.
  • To assess the impact of the intervention on specific documentation elements and overall sign-out scores.
  • To determine the sustainability of improvements with ongoing implementation.

Main Methods:

  • A quality improvement intervention involving collection and grading of written sign-outs using an 11-point checklist.
  • Direct, in-person feedback provided to general medicine ward teams.
  • Analysis of documentation elements before and after intervention implementation.

Main Results:

  • Significant improvements were observed in documentation of mental status, decisionality, lab/test results, level of acuity, anticipatory guidance, and future plans.
  • The use of vague language in sign-outs significantly declined.
  • Mean total sign-out scores improved from 7.0 to 8.2 out of 11 (P < .0001).

Conclusions:

  • A structured quality improvement intervention with regular feedback effectively enhances the quality of internal medicine residency sign-out documents.
  • The improvements were sustained over time, even with rotating residents.
  • This intervention model is adaptable for implementation in other residency programs and institutions to improve patient safety and continuity of care.