Pardon the Interruption(s)-Enabling a Safer Emergency Department Sign Out

Patient "handoffs" or "sign outs" in medicine are widely recognized as highly vulnerable times for medical errors to occur. The Emergency Department (ED) has been identified as an environment where these transitions of care at shift changes are particularly high-risk due to a variety of factors, including frequent interruptions, which can further lead to errors in transfer of information. Our primary objective was to evaluate whether simple interventions could minimize interruptions during the sign out period in an attempt to improve patient safety.

Multiple low-cost interventions were implemented, including an overhead chime, clerical staff diversion of phone calls and electrocardiograms, and prominent positioning of a movable pedestal sign. Utilizing a before-and-after study design, we directly observed team sign outs at various shift changes throughout the day over 2-month periods before and after implementation. Our primary outcome measure was the number of interruptions that occurred during designated sign out times. We also assessed total time spent in sign out, and a survey was sent to clinicians to assess their perception of sign out safety.

Total sign out interruptions were significantly decreased as a result of the above-noted interventions (average 6.1 vs 1.1; P < 0.01). Total time spent during sign out was reduced (14.1 vs 11.4 minutes; P < 0.04), and clinicians' perception of safety improved significantly, with Likert scores of 4 or 5 on a 5 point scale increasing from 47.4% before to 91.7% after implementation.

Patient sign out at shift change is a vulnerable time for patient safety and transition of care with interruptions further compromising the safe transfer of information. Simple interventions significantly decreased interruptions and were associated with shorter sign out periods and improved provider perception of sign out safety.