Controlled trial to improve resident sign-out in a medical intensive care unit

Abstract

Objective: Poor sign-out or handover of care may lead to preventable patient harm. Critically ill patients in intensive care units (ICU) are complex and prone to rapid clinical deterioration. If clinical deterioration occurs, timeliness of appropriate interventions is essential to prevent or reduce adverse outcomes. Therefore sign-outs need to efficiently transmit key information and provide anticipatory guidance. Interventions to improve resident-to-resident ICU sign-outs have not been well described. We conducted a controlled trial to test the effectiveness of a standardised ICU sign-out process to the usual ICU sign-out.

Design: Prospective controlled trial.

Setting: A 26-bed medical intensive care unit (MICU) in an urban tertiary academic medical centre.

Subjects: Residents rotating through the MICU.

Interventions: ICU-specific written sign-out template.

Methods: Residents completed postcall surveys assessing satisfaction with verbal and written sign-outs and incidence of non-routine events. Our main outcome of interest was the occurrence of non-routine events.

Main results: Compared with the intervention group, on significantly more nights, night float residents in the control group encountered patients who were sicker than sign-out would have suggested (15.94% vs 43.75%; p<0.0001). On significantly fewer nights, night float residents in the intervention group indicated that either something happened to patients that was unexpected (18.84% vs 36.51%; p=0.023) or they were insufficiently prepared for (4.35% vs 35.94%; p<0.0001). Similarly, on fewer nights, residents in the intervention group indicated that they had to perform interventions that were unplanned or unanticipated (15.9% vs 37.7%; p=0.005).

Conclusion: A structured sign-out process compared with usual sign-out significantly reduced the occurrence of non-routine events in an academic MICU.

Keywords: communication; critical care; handoffs; medical errors; non-routine events; patient safety; preventable adverse events.