Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.

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Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.

J Gen Intern Med. 2012 Mar;27(3):287-91

Authors: Helms AS, Perez TE, Baltz J, Donowitz G, Hoke G, Bass EJ, Plews-Ogan ML


BACKGROUND: Resident duty hour restrictions have resulted in more frequent patient care handoffs, increasing the need for improved quality of residents' sign-out process.

OBJECTIVE: To characterize resident sign-out process and identify effective strategies for quality improvement.

DESIGN: Mixed methods analysis of resident sign-out, including a survey of resident views, prospective observation and characterization of 64 consecutive sign-out sessions, and an appreciative-inquiry approach for quality improvement.

PARTICIPANTS: Internal medicine residents (n?=?89).

INTERVENTIONS: An appreciative inquiry process identified five exemplar residents and their peers' effective sign-out strategies.

MAIN MEASURES: Surveys were analyzed and observations of sign-out sessions were characterized for duration and content. Common effective strategies were identified from the five exemplar residents using an appreciative inquiry approach.

KEY RESULTS: The survey identified wide variations in the methodology of sign-out. Few residents reported that laboratory tests (13%) or medications (16%) were frequently accurate. The duration of observed sign-outs averaged 134 ±73 s per patient for the day shift (6 p.m.) sign-out compared with 59 ± 41 s for the subsequent night shift (8 p.m.) sign-out for the same patients (p?=?0.0002). Active problems (89% vs 98%, p?=?0.013), treatment plans (52% vs 73%, p?=?0.004), and laboratory test results (56% vs 80%, p?=?0.002) were discussed less commonly during night compared with day sign-out. The five residents voted best at sign-out (mean vote 11 ± 1.6 vs 1.7 ± 2.3) identified strategies for sign-out: (1) discussing acutely ill patients first, (2) minimizing discussion on straightforward patients, (3) limiting plans to active issues, (4) using a systematic approach, and (5) limiting error-prone chart duplication.

CONCLUSIONS: Resident views toward sign-out are diverse, and accuracy of written records may be limited. Consecutive sign-outs are associated with degradation of information. An appreciative-inquiry approach capitalizing on exemplar residents was effective at creating standards for sign-out.

PMID: 21997480 [PubMed - indexed for MEDLINE]

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