Sign-Out

Effective hand-offs must occur to ensure continuous high-quality care for our patients regardless of the time of day and which physician is taking care of patients.

Principles of error free handoffs

  • Communicate interactively, allowing and promoting questions

  • Communicate up-to-date information: treatment, services, condition, and recent or anticipated changes.

  • Limit interruptions

  • Allow sufficient time

  • Require a verification process: repeat-backs

  • Ensure the receiver has the opportunity to review data

Handoff document

  • Supplement verbal handoff

  • Allows receiver to follow along

  • Provides more comprehensive info

    • To include: Name/MR#/Location/Code status/ Attending name/Resident name/Team Contact/Family contact info

    • Active meds/ Current pt condition/Active clinical issues/Anticipated issues and what to do (If-Then guidance)/To-do List/To follow-up list

  • Prepared by patient’s primary provider for the day

  • Incorporate time for review and updating into daily workflow

  • Key Features: Succinct, Specific (if/then), Accurate, Up to date

Updating Sign-out in EPIC

Click ‘Write Handoff’ button in the Epic Toolbar once patient is selected

There are 3 sections:

Summary

  • Dot phrase for Summary is .umhneurososummary

  • List one liner and relevant interventions completed in HPI

  • List active issues that are medically concerning or covering resident will be paged about.

  • Keep it concise and relevant

  • List pertinent positive or negative exam findings

  • List relevant events from the day (hemodynamic instability, trach/PEG, etc)

Situational Awareness

  • Dot phrase for Situational Awareness is ..umhneurosositawareness

  • List only items for NF to follow up on that will change management emergently

    • Do not feel the need to list something if nothing is relevant

  • Provide guidance for possible events that could happen in If/Then:

Action List

  • Couple words to describe reason for admission

  • Major plans, feeding plan, breathing, dispo

Neurology Hand-off process

Face-to-face hand-off occurs at the change of shift as follows:

  • 5:00 PM in the Stroke Room – The Short Call resident will be available for verbal sign-out.

  • 8:30 PM: The Short-Call resident will hand-off to the Night Float resident in the Resident Library

  • 07:00 AM: The Night Float resident will be in the Library to hand-off back to the day team residents. Any overnight events will be reported back to the day teams in the morning.

  • Significant overnight events (e.g. called to see the patient for change in exam) should also be documented by the covering resident with a quick Progress Note in EPIC and with an asterixis (*) in the Hand off summary.

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Last Updated: July 16, 2024