We use the SBAR framework as a guide for communicating hand-off information; while it’s by no means perfect, it’s the most validated tool we have and comes recommended by the Joint Commission as an effective method for reducing the most common source of error leading to patient mortality.
- Sign-out disposition
- Pending evaluations
- Illness severity
- Problem/chief complaint
- Relevant PMH
- Relevant HPI
- Relevant exam
- Working diagnosis/differential
- Workup & results
- Vital signs
- ED course
- Next steps
- Pending studies, procedures
- Re-evaluations needed
- Conditional plans
Before your shift
Remind oncoming residents of sign-out best practices:
- limit interruptions
- use a structured framework
- read-back or closed-loop communication
Note whether residents acquired necessary information for each patient. Allow the resident receiving sign-out to ask clarifying questions before you step in.
Spend a couple minutes debriefing the sign-out. Did the resident acquire all of the necessary information? Ensure vital signs were communicated? Demonstrate closed loop communication of the plan and follow-up tasks? Are there behaviors the off-going team used that should or shouldn’t be adopted at the end of the shift?
Review expectations of organization and critical information for sign-out, including the SBAR framework.
It’s tempting to take over, but let the residents give and take their own sign-outs. If they miss crucial information, you should interject. Note whether you had to include other critical information, the oncoming team had confusion, the SBAR framework was used, vitals were included, and closed loop communication was utilized.
Time for reflection and feedback. Was all of the necessary information communicated in a concise way? What worked well? What was challenging? What would you recommend doing differently in the future?
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Cheung DS, Kelly JJ, Beach C, et al. Improving Handoffs in the Emergency Department. YMEM 2010;55(2):171–80.
Hern HG Jr., Gallahue FE, Burns BD, et al. Handoff Practices in Emergency Medicine: Are We Making Progress? Acad Emerg Med 2016;23(2):197–201.
Kessler CS, et al. The 5Cs of Consultation: Training Medical Students to Communicate Effectively in the Emergency Department. Journal of Emergency Medicine 2015;49(5):713–21.