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Patient handoff

Copyright © 2006 Society of Hospital Medicine

Patient handoff (or sign‐out) refers to the specific interaction, communication, and planning required to achieve seamless transitions of care from one clinician to another. Effective and timely sign‐outs are essential to maintain high quality medical care, reduce medical errors and redundancy, and prevent loss of information. Hospitalists are involved in the transfer of patient care on a daily basis and can lead institutional initiatives that promote optimal transfer of information between health care providers.

KNOWLEDGE

Hospitalists should be able to:

  • Describe key elements involved in signing out a patient.

  • Explain important information that should be communicated during patient sign‐out, which may include administrative details, updated clinical status, tasks to be completed and relative priority, severity of illness assessment, code status, and contingency planning.

  • Explain the components and strategies that are critical for successful communication during sign‐outs.

  • Explain how the components, strategies and specific information provided at sign‐out might vary depending on complexity of the patient, familiarity of provider with the patient and the care environment, and timing of sign‐out.

  • Explain the strengths and limitations of various sign‐out communication strategies and procedures.

SKILLS

Hospitalists should be able to:

  • Communicate effectively and efficiently during patient sign‐out.

  • Demonstrate the use of read back when communicating tasks.

  • Utilize the most efficient and effective verbal and written communication modalities.

  • Construct patient summaries for oral and written delivery, incorporating the unique characteristics of the patient, provider and timing of the sign‐out.

  • Evaluate all medications for indication, dosing, and planned duration at the time of sign‐out.

  • Document updated clinical status, recent and pending test and study results, a complete problem list, and plans for continued care.

  • Explain the importance of using if‐then statements for critical tasks to be completed.

  • Anticipate what may go wrong with a patient after a transition in care and communicate this clearly to the receiving clinician.

  • Synthesize medical information received from Hospitalists signing out patients into care plans

ATTITUDES

Hospitalists should be able to:

  • Inform patients and families in advance of sign‐out.

  • Recognize the impact of effective and ineffective sign‐outs on patient safety.

  • Appreciate the value of real time interactive dialogue between hospitalists during sign‐out.

  • Review received sign‐out summaries and communications information carefully and request clarification when needed.

  • Engage stakeholders in hospital initiatives to continuously assess the quality of sign‐outs.

  • Lead, coordinate or participate in initiatives to develop and implement new protocols to improve and optimize sign‐outs.

  • Lead, coordinate or participate in evaluation of new strategies or information systems designed to improve sign‐outs.

  • Promote availability after sign‐outs should questions arise.

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