A Randomized Cohort Controlled Trial to Compare Intern Sign-Out Training Interventions

Area of Science:

• Medical education
• Patient safety
• Healthcare quality improvement

Background:

• Implementing comprehensive sign-out protocols like the I-PASS (illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by reviewer) bundle can be resource-intensive.
• Evaluating the effectiveness of various training pedagogies is crucial for optimizing sign-out quality.

Purpose of the Study:

• To compare four different training interventions for medical residents.
• To determine which training approach best enhances multidimensional sign-out quality, focusing on information exchange, task accountability, and personal responsibility.

Main Methods:

• Four internal medicine firms were randomized to receive one of four training interventions: didactics (control), I-PASS bundle, policy mandate on task accountability, or Plan-Do-Study-Act (PDSA).
• Trained observers used a standardized checklist to assess sign-out quality over 10 days before and after interventions.

Main Results:

• All intervention groups (I-PASS, policy mandate, PDSA) showed significant improvements in specific areas of sign-out quality compared to the control group.
• The I-PASS bundle demonstrated the most substantial overall improvement in sign-out quality, particularly in patient information transfer and task accountability.

Conclusions:

• Specific training emphases effectively improve distinct dimensions of sign-out quality.
• A blended approach combining multiple training pedagogies may be optimal for achieving comprehensive improvements in medical sign-out quality.