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Use of an Appreciative Inquiry Approach to Improve Resident Sign-Out in an Era of Multiple Shift Changes
Journal article   Open access   Peer reviewed

Use of an Appreciative Inquiry Approach to Improve Resident Sign-Out in an Era of Multiple Shift Changes

Adam S. Helms, Thomas E. Perez, Joseph Baltz, Gerald Donowitz, George Hoke, Ellen J. Bass and Margaret L. Plews-Ogan
Journal of general internal medicine : JGIM, v 27(3), pp 287-291
01 Mar 2012
DOI: https://doi.org/10.1007/s11606-011-1885-4
PMID: 21997480
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1007/s11606-011-1885-4View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

General & Internal Medicine Health Care Sciences & Services Life Sciences & Biomedicine Medicine, General & Internal Science & Technology
BACKGROUND: Resident duty hour restrictions have resulted in more frequent patient care handoffs, increasing the need for improved quality of residents' sign-out process. OBJECTIVE: To characterize resident sign-out process and identify effective strategies for quality improvement. DESIGN: Mixed methods analysis of resident sign-out, including a survey of resident views, prospective observation and characterization of 64 consecutive sign-out sessions, and an appreciative-inquiry approach for quality improvement. PARTICIPANTS: Internal medicine residents (n=89). INTERVENTIONS: An appreciative inquiry process identified five exemplar residents and their peers' effective sign-out strategies. MAIN MEASURES: Surveys were analyzed and observations of sign-out sessions were characterized for duration and content. Common effective strategies were identified from the five exemplar residents using an appreciative inquiry approach. KEY RESULTS: The survey identified wide variations in the methodology of sign-out. Few residents reported that laboratory tests (13%) or medications (16%) were frequently accurate. The duration of observed sign-outs averaged 134 +/- 73 s per patient for the day shift (6 p. m.) sign-out compared with 59 +/- 41 s for the subsequent night shift (8 p. m.) sign-out for the same patients (p=0.0002). Active problems (89% vs 98%, p=0.013), treatment plans (52% vs 73%, p=0.004), and laboratory test results (56% vs 80%, p=0.002) were discussed less commonly during night compared with day sign-out. The five residents voted best at sign-out (mean vote 11 +/- 1.6 vs 1.7 +/- 2.3) identified strategies for sign-out: (1) discussing acutely ill patients first, (2) minimizing discussion on straightforward patients, (3) limiting plans to active issues, (4) using a systematic approach, and (5) limiting error-prone chart duplication. CONCLUSIONS: Resident views toward sign-out are diverse, and accuracy of written records may be limited. Consecutive sign-outs are associated with degradation of information. An appreciative-inquiry approach capitalizing on exemplar residents was effective at creating standards for sign-out.

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33 citations in Web of Science
34 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#4 Quality Education
#3 Good Health and Well-Being

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Health Care Sciences & Services
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