Sign-out Communication

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.  

Situation

- Sign-out disposition 

- Pending evaluations

- Illness severity

- Problem/chief complaint

Background

- Relevant PMH

- Relevant HPI

- Relevant exam

Assessment

- Working diagnosis/differential

- Workup & results

- Vital signs

- ED course

Recommendations

- 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

Taking sign-out

Note whether residents acquired necessary information for each patient. Allow the resident receiving sign-out to ask clarifying questions before you step in.

After sign-out

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?

Before sign-out

Review expectations of organization and critical information for sign-out, including the SBAR framework. 

Giving sign-out

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. 

After sign-out

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?