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Patient Signout

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1. Efficiency of electronic signout for ED-to-inpatient admission at a non-teaching hospital. (PubMed)

Efficiency of electronic signout for ED-to-inpatient admission at a non-teaching hospital. Admission handoff is a high-risk component of patient care. Previous studies have shown that a standardized physician electronic signout ("eSignout") may improve ED-to-inpatient handoff safety and efficiency in teaching hospitals. This model has not yet been studied in non-teaching hospitals. The objectives of the study were to determine the efficiency of an eSignout platform at a community affiliate (...) hospital by comparing ED length of stay (LOS) for a 5-month period before and after implementation and to compare the quality assurance (QA) events among admitted patients for the same time period. A retrospective, interventional study was conducted with the main outcome measures including ED LOS with calculation of 95% CI, mean comparison (t test), and number of QA events before and after implementation of the eSignout model. Prior to eSignout implementation, 1045 patients were admitted [mean ED LOS

2018 Internal and emergency medicine

2. Patient Signout

Patient Signout Patient Signout Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Patient Signout Patient Signout Aka: Patient Signout (...) , SIGNOUT Mnemonic , Patient Handoff , Admission Script II. Indications Safer Patient Handoffs (sign-outs) on shift changes (e.g. hospital ward, emergency department) Patient hand-off from a mid-level practitioner (PA, NP) to a physician III. Precautions Patient care hand-offs are high risk for error Initial provider should clearly transfer care to the accepting provider (avoiding interruptions) Concise summary of key history (include past medical history and medications) To-do list of pending results

2018 FP Notebook

3. Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. (Full text)

Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period.Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation.University-based, tertiary-care hospital.Internal medicine resident physicians admitting (...) completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related

2014 International Journal for Quality in Health Care PubMed

4. Understanding Physician Signout Risk Perception

Perspective: Prospective Official Title: Understanding Physician Signout Risk Perception Study Start Date : July 2015 Actual Primary Completion Date : February 2016 Actual Study Completion Date : February 2016 Groups and Cohorts Go to Group/Cohort Intervention/treatment Intern Interns are in their first year of residency. Other: Clinical deterioration Patients at risk of clinical deterioration Residents Residents are in their 2nd or 3rd year of residency. Other: Clinical deterioration Patients at risk (...) Understanding Physician Signout Risk Perception Understanding Physician Signout Risk Perception - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Understanding Physician Signout Risk Perception (UPS

2015 Clinical Trials

5. Patient Signout

Patient Signout Patient Signout Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Patient Signout Patient Signout Aka: Patient Signout (...) , SIGNOUT Mnemonic , Patient Handoff , Admission Script II. Indications Safer Patient Handoffs (sign-outs) on shift changes (e.g. hospital ward, emergency department) Patient hand-off from a mid-level practitioner (PA, NP) to a physician III. Precautions Patient care hand-offs are high risk for error Initial provider should clearly transfer care to the accepting provider (avoiding interruptions) Concise summary of key history (include past medical history and medications) To-do list of pending results

2015 FP Notebook

6. Improving Signout Accuracy and Information Delivery in the Emergency Department

Improving Signout Accuracy and Information Delivery in the Emergency Department Improving Signout Accuracy and Information Delivery in the Emergency Department - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more (...) . Improving Signout Accuracy and Information Delivery in the Emergency Department (SAID-ED) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01859286 Recruitment Status : Completed First Posted : May 21, 2013 Last Update Posted : May 21, 2013 Sponsor: The University of Texas Health Science Center, Houston

2013 Clinical Trials

7. IIPE-PRIS Accelerating Safe Signouts

IIPE-PRIS Accelerating Safe Signouts IIPE-PRIS Accelerating Safe Signouts - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. IIPE-PRIS Accelerating Safe Signouts (I-PASS) The safety and scientific validity (...) improving handoffs has been identified by AHRQ and the Joint Commission as a priority in nationwide efforts to improve patient safety. Comparative Effectiveness Research on handoff tools and processes has identified specific strategies to improve handoffs and reduce medical errors: 1) team training; 2) verbal mnemonics; and 3) use of written/computerized tools to supplement verbal sign-outs. To accelerate residents' use of CER-based handoff practices and improve patient safety, the investigators

2011 Clinical Trials

8. IM Ketamine for Prehospital Sedation of the Agitated Patient

IM Ketamine for Prehospital Sedation of the Agitated Patient Emergency Medicine > Journal Club > Archive > November 2016 Toggle navigation November 2016 IM Ketamine for Prehospital Sedation of the Agitated Patient Vignette You are working a night shift in EM-1 and have just started to catch up after signout, consisting of more than a few inebriated patients awaiting sobriety, when you hear commotion out in the hall. EMS and police are bringing in a large, screaming, Blailing, adult male patient (...) handcuffed to the stretcher. The paramedics report that the patient is known to them as a schizophrenic and the family called due to bizarre behavior and not taking his medications. As the security team puts on their gloves for what is likely to be a hazardous transfer of the patient to room 8, the nurse asks “5 and 2?” As you are about to say yes, the paramedics report that about 5 minutes ago they gave the patient 5mg IM haloperidol and 10mg IM midazolam. Judging by the severely agitated patient

2017 Washington University Emergency Medicine Journal Club

9. An Analysis of Team Checklists in Physician Signout Notes (Full text)

An Analysis of Team Checklists in Physician Signout Notes Teams of physicians in the hospital collaboratively maintain checklists in informal "signout" documents to help organize, manage, and hand off critical patient-based tasks. We created an application within our commercial EHR that supports basic management of these checklists at two urban, academic medical centers. We collected and analyzed over 400,000 checklist tasks created in the application. We calculated the frequencies of terms (...) and term-combinations (n-grams) in these lists, and compared these data with a previously described clinical task model. Our findings provide evidence for the generalizability of the original clinical task model, and provide the foundation for a more sophisticated physician checklist utility. This could contribute to improved efficiency and safety in patient care.

2010 AMIA Annual Symposium Proceedings PubMed

10. Communication Strategies for Patient Handoffs

liability insurers. Ann Emerg Med 2007;49:196–205. Singh H, Thomas EJ, Petersen LA, Studdert DM. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med 2007;167:2030–6. The Joint Commission. Comprehensive accreditation manual. CAMH for hospitals: the official handbook. Oakbrook Terrace (IL): Joint Commission; 2010. Agency for Healthcare Research and Quality. Patient safety primers: handoffs and signouts. Available at: . Retrieved July 28, 2011. Macones (...) Communication Strategies for Patient Handoffs Communication Strategies for Patient Handoffs - ACOG Menu ▼ Communication Strategies for Patient Handoffs Page Navigation ▼ Number 517, February 2012 (Replaces No. 367, June 2007) (Reaffirmed 2018) Committee on Patient Safety and Quality Improvement This document reflects emerging concepts on patient safety and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed

2012 American College of Obstetricians and Gynecologists

11. Quality Improvement in Handover of General Internal Medicine In-patients

Quality Improvement in Handover of General Internal Medicine In-patients Quality Improvement in Handover of General Internal Medicine In-patients - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Quality (...) Improvement in Handover of General Internal Medicine In-patients The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01796756 Recruitment Status : Completed First Posted : February 22, 2013 Last Update Posted : January 15, 2016 Sponsor: University of British Columbia Collaborator: Canadian Medical Protective

2013 Clinical Trials

12. Ketamine

) was administered orally every 12 hours for 1 week. When appropriate, ketamine (0.6 mg/kg/h) was administered IV for 6 hours on each of the first 3 days of tramadol administration 2012 13. IM Ketamine for Prehospital Sedation of the Agitated Patient Emergency Medicine > Journal Club > Archive > November 2016 Toggle navigation November 2016 IM Ketamine for Prehospital Sedation of the Agitated Patient Vignette You are working a night shift in EM-1 and have just started to catch up after signout, consisting (...) has been online since 1997 and in that time has developed into the internet’s premier source of evidence-based content. Our motto is ‘Find evidence fast’ and this is something we aim to deliver for every single search. As well as research evidence we also allow clinicians to search across other content types including images, videos, patient information leaflets, educational courses and news. For further information on Trip click on any of the questions/sections on the left-hand side of this page

2018 Trip Latest and Greatest

13. Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology (Full text)

pathology cases to detect disagreements and potential interpretive errors; (2) anatomic pathologists should perform case reviews in a timely manner to avoid having a negative impact on patient care; (3) anatomic pathologists should have documented case review procedures that are relevant to their practice setting; (4) anatomic pathologists should continuously monitor and document the results of case reviews; and (5) if pathology case reviews show poor agreement within a defined case type, anatomic (...) pathologists should take steps to improve agreement. Conclusions.— Evidence exists that case reviews detect errors; therefore, the expert panel recommends that anatomic pathologists develop procedures for the review of pathology cases to detect disagreements and potential interpretive errors, in order to improve the quality of patient care. Accepted: March 27, 2015; Published: May 12, 2015 © 2016 College of American Pathologists The test cycle in surgical pathology and cytology is similar to the test cycle

2016 College of American Pathologists PubMed

14. What you need to hear at your medical school graduation

-rounding got easier. I learned to manage sick patients. My tasks were done before the evening signout. With introspection and a heavy dose of realism, my self-image and my reality merged into one. The guilt of being a charlatan also receded, but I don’t expect it’ll ever truly go away. Every year, I see interns go through the same feelings of inadequacy and self-recrimination. While these feelings are powerful motivators for learning, they can also breed , depression and even . And this is why I (...) about ceremonies that feature costumes, protocols and rituals is that they confer upon participants a sense of change. Just look at weddings — the two people who approach the altar are altered when they leave. Similarly, to borrow from , a patient gown, a white coat and a physical exam can transform two strangers into a doctor and a patient. Between solemn recitations of the Hippocratic oath and congratulatory speeches, you might conclude that a magical metamorphosis has transpired. And while

2018 KevinMD blog

15. Intern year is still universally hard. Intern year is also universally great.

. “Um … are you OK?” “Yeah. No worries. My body’s just adjusting.” I go on to describe how every day at 4 p.m. after a 24-hour shift, I have a little dry heaving episode. So far no emesis. So far. My brother is absolutely horrified. Intern year is universally hard. As interns, we share experiences of days when we get to the hospital before the sun rises and do not have anything to eat after our 4:30 a.m. breakfast until signout is over at 6:30 p.m. If you are lucky, you catch a few minutes during (...) is racing with the thoughts of the day: Did I remember to replete all my patients? Did I order all the correct labs for tomorrow? Did I toss the extra lists and stickers into the HIPAA bins? And don’t forget, you still have to read and practice your hand skills. I remember back to my first medical school course: “Introduction to the Profession.” We read When the Spirit Catches You and You Fall Down; we wrote letters to ourselves to open after four years of medical school; we had small group discussions

2018 KevinMD blog

16. A pilot study to standardize and peer-review shift handoffs in an academic internal medicine residency program: The DOCFISH method. (Full text)

, and surrogate markers of patient safety were measured.Shift-handoff documents were collected January-February 2016 (control) April-June 2016 (intervention). Signouts were scored based on inclusion of seven elements: Daily events, Overnight events, Code status, Follow up tasks, If/then statements, 'sick or stable' and History present illness. The mnemonic 'DOCFISH' was taught in a grand-rounds forum then embedded into a shift-handoff tool within our electronic health record (EHR). Senior residents were (...) assigned to supervise/provide feedback on shift handoffs from April-June 2016. Faculty and resident perceptions regarding quality of shift handoffs was measured by the annual ACGME (Accreditation Council Graduate Medical Education) program survey.Patient safety was measured by number of rapid-response teams (RRT) initiated for unstable vital signs. Handoffs were 74% complete in intervention group and 60% in control group (p < .0001). Median DOCFISH features present in patients that required RRT was 3

2018 Medicine PubMed

17. What can physicians do to combat confirmation bias?

What can physicians do to combat confirmation bias? What can physicians do to combat confirmation bias? What can physicians do to combat confirmation bias? | | September 6, 2018 23 Shares The day begins at 6 a.m. I am rounding on my nine patients, quickly examining them and providing a brief update about the plan. Like the other harried residents, I am speeding from one room to the next, trying to get everything done on time. And then, inevitably my beeper goes off — “Patient in emergency room (...) being admitted, please call for signout.” I stop in my tracks. I can literally feel the time ticking away, and there is so much to do. But as I clear my mind to hear about the new admission, I have to remind myself of a lesson I learned as a medical student — the importance of slowing down. Ms. A was a petite woman in her early 40s with beautiful dark hair and a kind smile. She appeared rather calm despite her current woes — double vision and difficulty opening her left eye. I met her when she

2018 KevinMD blog

18. A Model for Electronic Handoff Between the Emergency Department and Inpatient Units. (PubMed)

A Model for Electronic Handoff Between the Emergency Department and Inpatient Units. Patient handoffs between units can introduce risk and time delays. Verbal communication is the most common mode of handoff, but requires coordination between different parties.We present an asynchronous patient handoff process supported by a structured electronic signout for admissions from the emergency department (ED) to the inpatient medicine service.A retrospective review of patients admitted to the medical (...) for verbal signout when deemed necessary. The process was rapidly adopted with the majority of patients being accepted electronically.Copyright © 2017 Elsevier Inc. All rights reserved.

2017 Journal of Emergency Medicine

19. An oncologist reflects on his inpatient internal medicine service

as an unpleasant but necessary evil to keep their RVUs up, but personally, I enjoy my time attending on the wards and, this time, more than most. Yes, I didn’t see my wife and son much for 15 days, I had to move into the spare bedroom to preserve marital harmony, and my New Year’s resolution to eat better and exercise was quickly put on hold, but there were many positive aspects as well. As a subspecialist in lung cancer, my time on the wards is my only chance to be a general oncologist and see patients (...) with everything from multiple myeloma to malignant melanoma. I get to diagnose new cases of high-grade lymphoma and stretch my chemo CHOPs beyond my standard fare of platinum doublets. I can even test my old internal medicine skills (board certified but not participating in MOC). Is that atrial flutter or was the patient shivering when this EKG was taken? The patient is eating a hot dog and watching the playoffs, but was admitted for sepsis because his lactate was high? Who wants to hear about pretest

2016 KevinMD blog

20. A resident’s guide to being a medical student

A resident’s guide to being a medical student A resident's guide to being a medical student A resident’s guide to being a medical student | | March 5, 2016 1K Shares Though I am two years into my residency, I still experience flashbacks to my time as a medical student on the wards. The adrenaline of arriving at the hospital 2 hours before rounds, scrambling to see my patients, constructing a note that no one would ever look at, and preparing a hastily-constructed presentation to deliver (...) in a half-performance, half-examination outside of our patient’s room. I remember being the object of a thousand microaggressions, coming from scrub-techs residents, nurses, and (gasp) attendings. I was always standing in the wrong corner, using the wrong computer, or choosing the wrong time or person to ask a question, things I would have gladly changed had I known how to do them right. Medical school seemed like a game, and I never understood the rules. Slowly, through getting fouls and penalties, I

2016 KevinMD blog

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