Standardized sign-out improves neurology handoffs

By Sarah Guy, MedWire Reporter

The implementation of a structured sign-out process significantly improves satisfaction that handoffs between neurology staff have been completed fully and accurately, show study results published in Neurology.

Resident neurologists reported being significantly more likely to share test results with patients and/or families before their shift changes and to update electronic service lists after implementation of the structured sign-out.

The structured system is based on the situation-background-assessment-recommendation (SBAR) format, explain Brian Moseley and co-investigators from the Mayo Clinic in Rochester, Minnesota, USA, and could be a "practical way to prevent communication failures during handoffs."

"This could have implications for neurology residents as they devise cross-coverage and night float systems to prevent duty hour violations," they add.

Moseley and colleagues conducted a survey to assess levels of satisfaction with existing sign-out systems among 23 postgraduate year 2-4 neurology residents.

The survey revealed several markers for improvement, including that the majority of respondents felt the sign-out process was too rushed, and that information including patient code status and recent changes in medications was not being communicated 100% of the time.

A total of 33 residents completed pre-SBAR structure implementation and 20 residents completed post-SBAR implementation surveys, revealing a significant overall satisfaction increase from 6.2 to 7.4 points on a 10-point scale.

Specifically, after implementation of the structured sign-out process, the percentage of residents who felt that all-important data were being transmitted at handoff increased significantly, from 49% to 80%.

The researchers highlight the low post-implementation response rate as a potential limitation of their results that could introduce sampling bias, and warn that busy inpatient neurology departments might put some residents off if more time is needed to complete sign-out. However, the team states that the findings deserve notice nevertheless.

In an accompanying editorial, Glen Finney (University of Florida, Gainesville) and Sheryl Martin-Schild (Tulane University of Health Science Center, New Orleans, Louisiana) remark upon the possibility of improvements to patient care with structured handoff systems.

The sign-out process "highlights once again the importance of communications throughout medical practice, especially as increased communication can increase quality of care and patient safety," they say.

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