Mason Merriel Rafael Ortega 7
Effective Sign-Out in Medicine: Ensuring Safe Transitions of Care
specific cases or decisions. Peer review involves the evaluation of a physician’s performance by colleagues to ensure that it aligns with the standard of care, and it serves as the foundation for medical quality assurance. It is crucial that these evaluations are shielded from legal consequences to prevent their use as punitive measures. The case of RaDonda Vaught, a nurse who faced criminal prosecution following a medication error resulting in patient death, has raised concerns about healthcare providers refraining from reporting errors due to fear of similar legal repercussions.
Learning Objectives 1. Identify the critical elements of a proper sign-out in the hospital setting, including essential patient information, pending tasks, and follow-up requirements, to ensure effective communication during transitions of care. 2. Understand the significance of standardized sign-out protocols and tools, such as SBAR, I-PASS, or SOAP, in promoting clear and concise communication, reducing errors, and improving patient safety during handovers. 3. Recognize the value of simulation-based training in enhancing sign-out skills, including effective communication, information organization, and critical thinking, to facilitate seamless transitions of care.
Suggested Reading 1 Grober, E. D., & Bohnen, J. M. A. (2005). Defining medical error. Canadian Journal of Surgery, Journal Canadien de Chirurgie, 48(1), 39-44. 2 Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353, i2139. doi:10.1136/bmj.i2139 3 Nanji, K. C., Patel, A., Shaikh, S., Seger, D. L., & Bates, D. W. (2016). Evaluation of perioperative medication errors and adverse drug events. Anesthesiology, 124(1), 25-34. doi:10.1097/ ALN.0000000000000904 4 Agency for Healthcare Research and Quality. (n.d.). Pocket guide: TeamSTEPPS. Retrieved April 11, 2023, from https://www.ahrq. gov/teamstepps/instructor/ essentials/pocketguide.html 5 Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. doi:10.2307/2666999 6 Marx, D. (2001). Patient safety and the “Just Culture”: A primer for health care executives. Prepared by David Marx, JD David Marx Retrieved February 23, 2022, from https://psnet.ahrq.gov/ issue/patient-safety-and-just- culture-primer-health-care- executives Consulting in support of Columbia University.
Promoting effective communication, especially in matters of quality and safety, necessitates the breakdown of barriers across different domains within the hospital.
Introduction Handing over patient care from one clinician to another or from one healthcare team to another is a critical step in healthcare delivery. This process, known as sign-out or handover, plays a crucial role in maintaining patient safety and continuity of care. Inappropriate or incomplete sign-outs can result in serious complications and patient harm. Therefore, it is essential to understand the key ingredients of a proper sign-out, identify specialties in greater need of improved handover practices, explore existing protocols, and discuss the benefits of simulation in enhancing sign-out skills. This chapter aims to provide healthcare professionals with practical guidance on conducting effective sign-outs, with real-life examples and mnemonic aids to facilitate this vital aspect of patient care. A sign-out and debriefing are two distinct processes in healthcare, serving different purposes and occurring at different stages of patient care. A sign-out is the process of transferring responsibility and relevant patient information from one healthcare provider or team to another. It typically occurs during shift changes or when care is transferred between different healthcare
settings (e.g., from the operating room to the post-anesthesia care unit). The primary objective of a sign-out is to ensure the accurate and comprehensive communication of patient information, including diagnosis, treatment plan, pending tests or consults, and any other relevant details necessary for the ongoing care of the patient. The focus is on continuity of care and the transfer of essential information to ensure a seamless transition without compromising patient safety. Debriefing, on the other hand, is a structured process of reflection and discussion that takes place after an event or experience. It typically occurs after a critical incident, a completed procedure, or the completion of a specific phase of care. While a sign-out primarily focuses on the transfer of patient information during care transitions, debriefing is a reflective process aimed at learning, improving performance, and enhancing team dynamics after an event or phase of care. Sign-outs are primarily concerned with patient safety and continuity of care, while debriefing is centered around professional growth, shared learning, and performance enhancement.
By establishing user-friendly and confidential reporting systems and safeguarding peer review protection, healthcare organizations can encourage open and honest communication about adverse events and medical errors. This fosters a culture of learning, improvement, and patient safety. Conclusion Effective communication among healthcare providers plays a vital role in preventing medical errors. However, several factors, such as the fear of confronting a superior or offending a peer, as well as concerns about legal and professional consequences, often hinder healthcare providers from addressing questionable practices or admitting doubts and errors. Encouraging open and honest discussions about these challenges, implementing user-friendly reporting systems, and fostering a just culture where practitioners feel safe to offer constructive criticism are crucial long-term practices that can enhance both patient safety and the overall working environment in healthcare.
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