Improving Signout Accuracy and Information Delivery in the Emergency Department

Study Overview
=================
Brief Summary
-----------------
The investigators sought to determine if implementing a standardized sign out process would reduce the amount of medical errors related to patient sign out. The standardized process included the following interventions: implementation of a data resident to review patients lab values, vital signs, radiologist results, and orders in real time, conducting sign out in a standardized location and using the attending physician as an interruption manager. The investigators defined medical errors related to sign out as any piece of information was incorrectly reported or omitted during sign out that caused a change in treatment or disposition discussed during sign out. The investigators hypothesis was that implementing a standardized sign out process would lead to a decrease in the amount of sign out related errors.

Official Title
-----------------
Improving Transfer of Care Accuracy and Information Delivery in the Emergency Department

Conditions
-----------------
Medical Errors Related to Emergency Department Sign Out

Intervention / Treatment
-----------------
* Other: standardized sign out process


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: ED transfers of care occurring at 0700 or 1900. Exclusion Criteria: Attending only handovers (1500, 2300) Handovers including midlevel providers (Thursday 0700, 1300).
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| regular sign out process<br> | Other: standardized sign out process<br>* The intervention phase included was the introduction of a standardized TOC (transfer of care) process, which occurred during April and May of 2012. TOC was done at a predefined location in each section of the emergency department (Medicine and Trauma). All participating residents were given a diagram detailing the central location and seating arrangement. The outgoing attending was designated to handle all distractions or disturbances that occurred during sign out. The most senior resident coming on to shift was designated the data resident. The data resident's role was to operate a centralized computer with the ED tracking board and EMR and review pending orders, vital signs and resulted labs and radiology reports after each patient was signed out. A brief pause was implemented to allow the oncoming team to ask any questions regarding that patient's care or course. The post TOC data form and protocol were identical to that of the control phase.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sign out related errors |  | 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| perception of sign out |  | 1 year after implementation of revised sign out process |