The Impact of Duty Cycle Workflow on Sign-out Practices: a Qualitative Study of an Internal Medicine Residency Program in Maryland, USA

Overview

Journal BMJ Open

Specialty General Medicine

Date 2017 May 11

PMID 28487461

Citations 1

Authors

Soo-Hoon Lee

Sanjay V Desai

Phillip H Phan

Affiliations

Soon will be listed here.

Abstract

Objectives: Although JCAHO requires a standardised approach to handoffs, and while many standardised protocols have been tested, sign-out practices continue to vary. We believe this is due to the variability in workflow during inpatient duty cycle. We investigate the impact of such workflows on intern sign-out practices.

Design: We employed a prospective, grounded theory mixed-method design.

Setting: The study was conducted at a residency programme in the mid-Atlantic USA. Two observers randomly evaluated three types of daily sign-outs for 1 week every 3 months from September 2013 to March 2014. The compliance of each observed behaviour to JCAHO's Handoff Communication Checklist was recorded.

Participants: Thirty one interns conducting 134 patient sign-outs were observed randomly among the 52 in the programme.

Results: In the 06:00 to 07:00 sign-back, the night-cover focused on providing information on overnight events to the day interns. In the 11:00 to 12:00 sign-out, the night-cover focused on transferring task accountability to a day-cover intern before departure. In the 20:00 to 21:00 sign-out, the day interns focused on transferring responsibility of their patients to a night-cover.

Conclusion: Different sign-out periods had different emphases regarding information exchange, personal responsibility and task accountability. Sign-outs are context-specific, implying that across-the-board standardised sign-out protocols are likely to have limited efficacy and compliance. Standardisation may need to be relative to the specific type and purpose of each sign-out to be supported by interns.

Citing Articles

"Do You Know What I Know?": How Communication Norms and Recipient Design Shape the Content and Effectiveness of Patient Handoffs.

Rattray N, Flanagan M, Militello L, Barach P, Franks Z, Ebright P J Gen Intern Med. 2018; 34(2):264-271.

PMID: 30535752 PMC: 6374251. DOI: 10.1007/s11606-018-4755-5.

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