Safer Sign Out Protocol
"Sign out is the most dangerous procedure in the emergency department" - Chaz Schoenfeld
One of the most critical actions we do in the emergency department is "handing off" the care of patients. When this is done during ED shift change we often call it "Signing Out". It is an unavoidable part of the care process and is fraught with vulnerability for the patient, the providers and the system.
While most practitioners can relay stories of mishaps during the process there are few established standards or protocols for improving the sign out process. Utilizing recommendations from the QIPS white paper "Improving Handoffs in the Emergency Department", as well as expert consensus, we designed a Safer Sign Out protocol that would help bring needed resiliency and reliability to signing out.
It is designed to provide a "standard method" for signing out and thus creates a shared understanding of the process. In addition, the protocol helps physicians/practitioners approach the process is a purposeful manner.
The key steps in strengthening the process:
Proactively prompts the off going physician to specifically and clearly record which patients are being signed out and to identify the critical items that pertain to the patient as well as which items are pending.
This step allows both practitioners to review the sign out template as well as other data such as labs or other studies. It provides an interactive opportunity to assure there is a "shared understanding" of what has been done and what is still needed.
This is an important but often omitted step in sign out. Briefly seeing the patient together allows the patients and the providers to have a better understanding of what is taking place. If a picture is worth a thousand words then visit is worth many more. In addition, this is a significant patient satisfier.
4) Relay to the Nurse/Team
This is an important component for increasing awareness of key active clinical issues and for assuring that there is a shared understanding for the team caring for the patient. Either the off-going or on-coming clinician should communicate the transition and exchange information with the responsible nurse/team members.
5) Receive Feedback
Timely feedback is an important part of best practices. Too often we do not get the opportunity. The sign out form allows the on-coming physician to record the outcome of the sign out and to provide the off going physician the result in a reliable and asynchronous manner. The form can be placed in the physician's mailbox if it is in a secure and HIPPA compliant location.
Executive Summary of Safer Sign Out, Sign Out Form, Educational Poster of Safer Sign Out, Implementation Presentation for Safer Sign Out , Tracker for ABEM MOC APP PI project
This educational poster (shown below) can be mounted on a wall or placed on an acrylic countertop holder (pictured) to help reinforce the key components and best practices of the Safer Sign Out process.