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. “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
changes were noted in handoffs being documented in the patient's medical record (57.4%), the percentage of computer/electronic signouts, or the level of dissatisfaction with handoff tools (54.1%). Less than two-thirds of respondents (80 of 126, 63.5%) indicated that their residents were "competent" or "extremely competent" in delivering and receiving handoffs.An insufficient level of handoff training is currently mandated or available for EM residents, and their handoff skills appear to be developed (...) Handoff Practices in Emergency Medicine: Are We Making Progress? Transitions of care present a risk for communication error and may adversely affect patient care. This study addresses the scope of current handoff practices amongst U.S. emergency medicine (EM) residents. In addition, it evaluates current educational and evaluation practices related to handoffs. Given the ever-increasing emphasis on transitions of care in medicine, we sought to determine if interval changes in resident transition
, and our step-by-step approach to compartment syndrome prevention, detection, and early intervention. The development and progression of compartment syndrome is multifactorial, and as complexity of care increases, the opportunity for the syndrome to be missed is increased. Recent changes in the structure of in-hospital medical care including resident work hour restrictions and the incorporation of midlevel providers have increased the frequency of "signouts" or "patient handoffs" which present (...) opportunities for the syndrome to be mismanaged.The changing dynamics of the health care team have prompted the need for a more explicit algorithm for managing patients at risk for compartment syndrome to ensure appropriate conveyance of information among team members.
, and situational awareness. The electronically administered survey used Likert frequency scales.Of 732 handoffs, 98% used the checklist, and 89% were complete. A mean of 1.7 potential safety events were identified per handoff. The most frequent potential safety events were identification of intensive care unit-level patients in the ED (48%), equipment problems (46%), staffing issues (21%), and intensive care unit-level patients in transport (16%). Eighty-one subjects (88%) responded to the survey. The users (...) agreed that the checklist promoted better communication, safety, efficiency, effective care, and situational awareness.The Physician Active Shift Signout in the Emergency Department briefing checklist was used often and at a high completion rate, frequently identifying potential safety events. The users found that it improved the quality of care and team communication. Future studies on outcomes and processes are needed.
survey administered in 2010.Rising fourth-year students at two large urban private medical schools.Participation and confidence in active and passive behaviors related to written signout and verbal handoffs during participants' third-year clerkships.Seventy percent of students (n = 204) responded. As third-year medical students, they reported frequent participation in handoffs, such as updating a written signout for a previously admitted patient (58 %). Students who reported frequent participation (...) (at least weekly) in handoff tasks were more likely to report being confident in that task (e.g., giving verbal handoff 62 % vs. 19 %, p < 0.001). Students at one site that did not have a handoff policy for medical students reported greater participation, more confidence, and less desire for training. Nearly all students believed they had witnessed an error in written signout (98 %) and almost two-thirds witnessed an error due to verbal handoffs (64 %).During their third year, many medical students
before-and-after the institution of an EMR on July 1st, 2010. No residents from the 2009-2010 class used the EMR, while all of the 2010-2011 residents used the EMR. We performed univariate and multivariate analyses using productivity, measured in patients per hour (pt/hr), as the primary outcome. A mixed-model multivariate regression, stratified by acuity zone, was created incorporating EMR and other possible confounders: admissions, signouts, daily ED volume, and days after July 1st for each shift (...) Evaluating how electronic charting affects resident productivity. Electronic medical records (EMRs) are becoming standard to improve the communication of information and longevity of patient records. Using an EMR in the emergency department (ED) could potentially slow residents evaluating patients. We evaluated how introducing an EMR affected resident productivity in an academic ED. We retrospectively studied first year emergency medicine residents from a large, academic, tertiary care center
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
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
, celebrations, and last-minute 4 th year getaways is when the real work begins! In honor of this upcoming Match day, I sifted through piles of index cards, scribbled notes, and signouts, to reflect on my first year of learning to be a doctor, also known as that formidable intern year of residency. When you are at the bottom of the totem pole, there is no shortage of work. I worked over 3,000 hours during intern year, with approximately 5 days off per month. By comparison, the average full-time American (...) employee works about annually, with 8 days off per month. I worked most federal holidays and even after explaining to my mom several times over the years, she still gets bewildered when I tell her, “Yes I AM working Thanksgiving … no, hospitals DON’T close just because it’s Christmas.” “A typical day” in the life of an internal medicine intern consists of rising as early as 5 a.m. (while on an inpatient hospital wards rotation with a full census of patients) or as “late” as 7 a.m. to head to clinic
Windows From Related Chapters II. Technique: Shortcuts Cycle through applications Alt-Tab Alt-Shift-Tab Windows Administrative Menu (from Start Button) Win-X Windows Task Manager (and signout, switch user, lock) Ctrl-Alt-Del Windows Lock Machine Win-L III. Approach: Upgrade Utilities User State Migration Tools (USMT) Available as command line and GUI tools to migrate user files and settings with upgrade Windows Deployment Services Microsoft utility to deploy an installation image (e.g. Windows 10 (...) in Medical Informatics About FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns
Corrective Strategies Take a 5-10 min break to recharge, walk, eat, drink every 3-4 hours Remove yourself from distracting conversations or activities Reassess your patient list every 2-3 hours Write down each patient, their acuity, and remaining barriers to disposition Starting with highest acuity patient, complete next task Make an exit plan in the final 1-2 hours of a shift Which patients will need admission, transfer to another facility, or signout to oncoming provider? Which patients need additional (...) Mnemonic , Thin Slicing , Thick Slicing , Self-Talk Incrementalization , Risk Shifting II. Background Diagnostic Inference Revise opinion based on imperfect information Associated with predictable patterns of bias (see cognitive mistakes below) Blois' Funnel Differential diagnosis is honed and refined during the course of patient evaluation III. Precautions: Shift Fatigue Energy and focus diminish over the course of a work shift End of shift is common and may result in less ideal management decisions
. Secondary Outcome Measures : Rates of total medical errors [ Time Frame: July 2010 ] As above, but includes both those errors involving residents and those involving all other clinical personnel. Minutes residents spend updating the signout; minutes spent in direct patient care; minutes spent working at computer [ Time Frame: July 2010 ] Resident reported experience of care [ Time Frame: July 2010 ] Self-reported, Likert scales on survey instruments. Rates of verbal miscommunications [ Time Frame: July (...) Implementing a Comprehensive Handoff Program to Improve Pediatric Patient Safety Implementing a Comprehensive Handoff Program to Improve Pediatric Patient Safety - 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
Implementing a Comprehensive Handoff Program to Improve Patient Safety Implementing a Comprehensive Handoff Program to Improve Patient Safety - 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. Implementing (...) a Comprehensive Handoff Program to Improve Patient Safety 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: NCT01130987 Recruitment Status : Completed First Posted : May 26, 2010 Last Update Posted : June 18, 2014 Sponsor: Brigham and Women's Hospital Collaborators: United States Department of Defense Walter Reed
in favor of other solutions). The investigators hypothesize that a web-based handoff tool improves provider satisfaction, the quality of written sign-outs, and measures of continuity of care compared with current handoff tools. Condition or disease Intervention/treatment Phase Continuity of Patient Care Workflow Quality of Signout Other: Signout tool Not Applicable Detailed Description: This study will attempt to answer the following questions: What are the specific needs for clinical content among (...) : Jeffrey L. Schnipper, MD.,MPH., Associate Professor of Medicine, Brigham and Women's Hospital ClinicalTrials.gov Identifier: Other Study ID Numbers: 2010P002915 First Posted: July 21, 2011 Last Update Posted: April 28, 2014 Last Verified: April 2014 Keywords provided by Jeffrey L. Schnipper, MD.,MPH., Brigham and Women's Hospital: Continuity of patient care Workflow Quality of signout Web based Handoffs Multi disciplinary Written signout Information science
Are troponin levels useful in ESRD? Renal Fellow Network: Are troponin levels useful in ESRD? | | | | | Tuesday, May 17, 2011 Are troponin levels useful in ESRD? I recently admitted a dialysis patient to a general medicine service for shortness of breath. When receiving signout from the ED resident, she told me that his troponin T was elevated, but since he had had prior high troponin levels, she was not concerned. I decided to do a quick review on troponin levels in dialysis patients in order (...) to help me assess the patient’s cardiovascular risk. Two main isoforms of troponin are currently used in hospital laboratory assays: troponin T (TnT) and troponin I (TnI). Both are extremely sensitive and specific markers of cardiac ischemia. However, they differ in size and response of serum levels to dialysis. Troponin T is a 37 kDa protein that is elevated in between 30 and 85% of ESRD patients. It is poorly dialyzed, and is cleared by the reticuloendothelial system. TnT levels are either unchanged
What â€œTo-Doâ€ with Physician Task Lists: Clinical Task Model Development and Electronic Health Record Design Implications Clinical task, or "to-do" lists are a common element in the physician document known as signout. Such lists are used to capture and track patient care plan items, supporting daily workflow and collaborative patient management continuity across care transitions. While physician task lists have been shown to be important to patient safety, the tasks themselves have not been (...) systematically examined for their subject matter, structure, or components. A manual sublanguage analysis of 500 signout tasks was conducted, and a hierarchical conceptual model for clinical tasks was inductively constructed. Tasks were classified by action type (Assess, Order, Communicate, Perform) and corresponding components. The most common task action types were Assess and Order. The most common task components were "What" type components such as Tests, including subtypes Laboratory and Imaging
Development and implementation of an oral sign-out skills curriculum. Imperfect sign-out of patient information between providers has been shown to contribute to medical error, but there are no standardized curricula to teach sign-out skills. At our institution, we identified several deficiencies in skills and a lack of any existing training.To develop a sign-out curriculum for medical house staff.Internal medicine residency program.We developed a 1-h curriculum and implemented it in August (...) of 2006 at three hospital sites. Teaching strategies included facilitated discussion, modeling, and observed individual practice with feedback. We emphasized interactive communication, a structured sign-out format summarized by an easy-to-remember mnemonic ("SIGNOUT"), consistent inclusion of key content items such as anticipatory guidance, and use of concrete language.We received 34 evaluations. The mean score for the course was 4.44 +/- 0.61 on a 1-5 scale. Perceived usefulness of the structured
or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 18 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: All medical in-patients who are coded moderately ill with fair to poor function in the SIGNOUT program will be asked (...) to participate in our study. Patients who are able to provide verbal consent for their participation will be enrolled. Exclusion Criteria: Any patient not coded in the SIGNOUT system as moderately ill with fair to poor function. Patients who refuses not to participate in the study. Patients who are unable to give written informed consent. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using
Signout: A Collaborative Document with Implications for the Future of Clinical Information Systems Signout is an unofficial clinical document used traditionally to facilitate patient handoff. Qualitative studies have suggested its importance in clinical care. We used a novel technique to quantify the use of signout by analyzing clinical information system logfiles. Viewing and editing events were collected for 1,677 unique patients admitted to our internal medicine service. We found the average (...) patient'ssignout on a given day is viewed frequently (>6x) and edited frequently (>2x) with multiple unique viewers (>3) and editors (>1). We also found that signouts are used throughout a 24-hour period, not just at the time of handoff. Finally, we showed that they are viewed months and even years after their creation. Signout is therefore a highly utilized, collaborative, clinical document used for more than patient handoff. Our findings also suggest that clinical information systems may benefit from