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Cited by 20Hospital Admissions and OutcomesPatient Safety and Medication ErrorsFamily and Patient Care in Intensive Care Units

Controlled trial to improve resident sign-out in a medical intensive care unit

Nanchal, Rahul, Aebly, Brian, Graves, Gabrielle, Truwit, Jonathon, Kumar, Gagan, Taneja, Amit, Dagar, Gaurav, Graf, Jeanette +3 more·2017·BMJ Quality & Safety
DOI 10.1136/bmjqs-2017-006657
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Abstract

OBJECTIVE: Poor sign-out or handover of care may lead to preventable patient harm. Critically ill patients in intensive care units (ICU) are complex and prone to rapid clinical deterioration. If clinical deterioration occurs, timeliness of appropriate interventions is essential to prevent or reduce adverse outcomes. Therefore sign-outs need to efficiently transmit key information and provide anticipatory guidance. Interventions to improve resident-to-resident ICU sign-outs have not been well described. We conducted a controlled trial to test the effectiveness of a standardised ICU sign-out process to the usual ICU sign-out. DESIGN: Prospective controlled trial. SETTING: A 26-bed medical intensive care unit (MICU) in an urban tertiary academic medical centre. SUBJECTS: Residents rotating through the MICU. INTERVENTIONS: ICU-specific written sign-out template. METHODS: Residents completed postcall surveys assessing satisfaction with verbal and written sign-outs and incidence of non-routine events. Our main outcome of interest was the occurrence of non-routine events. MAIN RESULTS: Compared with the intervention group, on significantly more nights, night float residents in the control group encountered patients who were sicker than sign-out would have suggested (15.94% vs 43.75%; p<0.0001). On significantly fewer nights, night float residents in the intervention group indicated that either something happened to patients that was unexpected (18.84% vs 36.51%; p=0.023) or they were insufficiently prepared for (4.35% vs 35.94%; p<0.0001). Similarly, on fewer nights, residents in the intervention group indicated that they had to perform interventions that were unplanned or unanticipated (15.9% vs 37.7%; p=0.005). CONCLUSION: A structured sign-out process compared with usual sign-out significantly reduced the occurrence of non-routine events in an academic MICU.

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Crossref · 10.1136/bmjqs-2017-006657

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  • Observational studies of structured handoff process have shown mixed effects on clinical events, ICU readmission, length of stay, mortality, and hospital readmission.

    “Observational studies of structured handoff process have demonstrated mixed effects, with some finding reductions in unexpected clinical events [569], or ICU readmission [570, 571] and others without impact upon length of stay [572], mortality [572, 573] or hospital readmission [572, 573].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [569]

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Authors
Nanchal, R., Aebly, B., Graves, G., Truwit, J., Kumar, G., Taneja, A., Dagar, G., Graf, J., Hubertz, E., Ramalingam, V., & Fletcher, K. E.
Affiliations
  • Medical College of Wisconsin (US)
  • Froedtert Hospital (US)
  • Phoebe Putney Memorial Hospital (US)
Corresponding author
Nanchal, Rahul
ORCID
Venue
BMJ Quality & Safety
Publisher
BMJ
Published
2017-08-07
Volume
26
Issue
12
Pages
987-992
ISSN
  • 1475-3898 (ISSN-L)
  • 2044-5415
  • 2044-5423
DOI
10.1136/bmjqs-2017-006657
OpenAlex
W2743550140
Cited by
20
References
28
Citations by year
2026: 1 · 2025: 3 · 2023: 2 · 2022: 2 · 2021: 5 · 2020: 2 · 2019: 5
FWCI
2.43
Type
journal article
Language
en
Open access
closed
Locations
  • BMJ Quality & Safety (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
Keywords
handover, sign-out, medical intensive care unit, night float, clinical deterioration, patient safety, anticipatory guidance
MeSH terms
Continuity of Patient Care, Humans, Intensive Care Units, Internship and Residency, Physicians, Surveys and Questionnaires, Critical Illness, Urban Health Services, Medical Errors, Patient Handoff, Tertiary Care Centers

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