by Brandon H. Abbott, DO, MPH
Since the restriction on resident duty work hours was passed by the Accreditation Council for Graduate Medical Education (ACGME) more than a year ago, I’ve found myself participating in patient handoffs more frequently in 2012 than ever before.
Rather than contemplating a slimmer waistline or kicking a bad habit, I felt my New Year’s resolutions would be better suited to helping others by practicing a more effective handoff, thus improving patient safety through handoff communication.
I resolve to incorporate the following five actions into my sign-outs for every patient, every time.
1. Code status is accurate
After discussing advance directives with my patients so that we’re on the same page about their end-of-life wishes, I will ensure that I can successfully communicate their wishes to my colleagues who may be covering for me.
It would be a terrible disservice to my patients that have an end-of-life event and their wishes were not respected as a result of my failure to communicate.
2. I will provide those on the night shift with clear plans and instructions
This will be an exercise in handoff communication and a way to help me fine tune my medical knowledge to anticipate the possible trajectories of my patients. I pledge to provide night shift teams with clear to-do’s and if/then instructions for the care of my patients and the rationale for them.
Taking a moment to consider where my patient might be headed from a clinical standpoint and proactively developing a contingency plan will help me become a better clinician. Breaking down the to-do’s and if/then plans will aid my colleagues – who do not know my patient in detail like I do – in managing the patient’s care in my absence.
3. I will apply Situation, Background, Assessment, Recommendation (SBAR) analysis to sign out
Taking a tip from our nursing colleagues who are effectively using SBAR in their clinical transitions, I will sign out my patients to the incoming physician in a succinct, structured manner using the SBAR format (see Resolution #2).
By using “SBAR,” my sign outs will be structured and methodical, thus ensuring I do not miss information or inadvertently lead to misinformation.
4. I will ensure medications are accurate
I resolve to update my medication lists during rounds and throughout the day, if necessary, so that the list is accurate and up-to-date when patient care decisions are made. Doing so will help with discharge planning and ensuring the patient receives the appropriate medication instructions when they leave the hospital to help reduce the potential for readmission.
5. I will use my sign-out tool to augment a great verbal sign out
See Resolutions 1-4. Additionally, I will take this year as an opportunity to improve how I verbally communicate critical information to my physician colleagues. I recognize that having a concise, accurate written sign-out assists other team members in managing a patient’s care. However, a good verbal sign-out will emphasize and contextualize important facts about my patients. A verbal sign-out also creates a dialogue about my patients and offers the opportunity for me to learn more from my colleagues about their opinions and feedback about what might be going on with my patients.
What will you resolve to do to help improve the continuity of care for your patients?
-Brandon H. Abbott, DO, MPH is a med-peds resident and a Smart Sign Out evangelist working to improve the patient handoff process.