Improving Signout Accuracy and Information Delivery in the Emergency Department (SAID-ED)

Improving Transfer of Care Accuracy and Information Delivery in the Emergency Department

The investigators sought to determine if implementing a standardized sign out process would reduce the amount of medical errors related to patient sign out. The standardized process included the following interventions: implementation of a data resident to review patients lab values, vital signs, radiologist results, and orders in real time, conducting sign out in a standardized location and using the attending physician as an "interruption manager." The investigators defined medical errors related to sign out as any piece of information was incorrectly reported or omitted during sign out that caused a change in treatment or disposition discussed during sign out. The investigators hypothesis was that implementing a standardized sign out process would lead to a decrease in the amount of sign out related errors.

Study Overview

• Status: Completed
• Conditions: Medical Errors Related to Emergency Department Sign Out
• Intervention / Treatment: Other: standardized sign out process

• Study Type: Observational
• Enrollment (Actual): 321

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • Memorial Hermann Hospital - Texas Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

ED Physicians. We looked at the amount of errors due to signout that ED Physicians commit with standard signout procedure and then with a revised signed out process

Description

Inclusion Criteria:

• ED transfers of care occurring at 0700 or 1900.

Exclusion Criteria:

• Attending only handovers (1500, 2300)
• Handovers including midlevel providers (Thursday 0700, 1300).

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

regular sign out process

Other: standardized sign out process; The intervention phase included was the introduction of a standardized TOC (transfer of care) process, which occurred during April and May of 2012. TOC was done at a predefined location in each section of the emergency department (Medicine and Trauma). All participating residents were given a diagram detailing the central location and seating arrangement. The outgoing attending was designated to handle all distractions or disturbances that occurred during sign out. The most senior resident coming on to shift was designated the data resident. The data resident's role was to operate a centralized computer with the ED tracking board and EMR and review pending orders, vital signs and resulted labs and radiology reports after each patient was signed out. A brief pause was implemented to allow the oncoming team to ask any questions regarding that patient's care or course. The post TOC data form and protocol were identical to that of the control phase.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Sign out related errors	4 months

Secondary Outcome Measures

Outcome Measure	Time Frame
perception of sign out	1 year after implementation of revised sign out process

Collaborators and Investigators

• Sponsor: The University of Texas Health Science Center, Houston
• Investigators: Principal Investigator: Nnaemeka G Okafor, MD, UT Houston Health Sciences Center at Houston Department of Emergency Medicine

Study record dates

Study Major Dates

• Study Start: February 1, 2012
• Primary Completion (Actual): May 1, 2012

Study Registration Dates

• First Submitted: April 27, 2013
• First Submitted That Met QC Criteria: May 17, 2013
• First Posted (Estimate): May 21, 2013

Study Record Updates

• Last Update Posted (Estimate): May 21, 2013
• Last Update Submitted That Met QC Criteria: May 17, 2013
• Last Verified: May 1, 2013

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: HSC-MS-11-0655