Premium
Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign‐out
Author(s) -
Vidyarthi Arpana R.,
Arora Vineet,
Schnipper Jeffrey L.,
Wall Susan D.,
Wachter Robert M.
Publication year - 2006
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.103
Subject(s) - hospital medicine , medicine , discontinuity (linguistics) , sign (mathematics) , health care , medline , best practice , family medicine , mathematical analysis , mathematics , management , economics , economic growth , political science , law
BACKGROUND Restrictions in the hours residents can be on duty have resulted in increased sign‐outs, that is, transfer of patient care information and responsibility from one physician to a cross‐coverage physician, leading to discontinuity in patient care. This sign‐out process, which occurs primarily in the inpatient setting, traditionally has been informal, unstructured, and idiosyncratic. Although studies show that discontinuity may be harmful to patients, this is little data to assist residency programs in redesigning systems to improve sign‐out and manage the discontinuity. PURPOSE This article reviews the relevant medical literature, current practices in non–health professions in managing discontinuity, and summarizes the existing practice and experiences at 3 academic internal medicine hospitalist‐based programs. CONCLUSIONS We provide recommendations and strategies for best practices to design safe and effective sign‐out systems for residents that may also be useful to hospitalists working in academic and community settings. Journal of Hospital Medicine 2006;1:257–266. © 2006 Society of Hospital Medicine.