Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events

Many medical injuries are preventable, but there are few reported successful strategies to prevent such injuries. Previous work identified coverage by house staff not primarily responsible for the patient (cross-coverage) as a significant correlate of risk for preventable adverse events. A four-month intervention--computerized sign-outs--was introduced in 1993 in an urban teaching hospital to improve continuity of care during cross-coverage and thereby reduce risk for preventable adverse events.

A previously tested confidential self-report system was used to identify adverse events, which were defined as unexpected complications of medical therapy that resulted in increased length of stay or disability at discharge. A panel of three board-certified internists confirmed events and evaluated preventability based on case summaries.

After the intervention, the rate of preventable adverse events among the 3,747 patients admitted to the medical service decreased from 1.7% to 1.2% (p < 0.10). Both univariate and multivariate analysis revealed no association between cross coverage and preventable adverse events after the intervention. In the baseline period, the odds ratio (OR) for a patient suffering a preventable adverse event during cross coverage was 5.2 (95% confidence interval [CI], 1.5-18.2; p = 0.01), but was no longer significant after the intervention (OR, 1.5; 95% CI, 0.2-9.0).

House staff are willing participants in efforts to measure and improve the quality of health care systems. The intervention may have reduced the risk for medical injury associated with discontinuity of inpatients care. Four years after the end of the study, the computerized sign-out program remained an integral part of the computing support system for house staff and was widely used.