MedEdPORTAL (Mar 2014)
UPDATED: A Signout Audit Tool to Address ACGME Milestones and Entrustable Professional Activities in Patient Handoffs
Abstract
Abstract Introduction When patient care is handed off to covering residents who may not have prior knowledge of patients, it is critical to ensure a properly created and well-maintained written signout document. The UPDATED resource was created to evaluate the quality of written signouts used by residents to augment patient handoffs in accordance with internal medicine milestones put forth by the ACGME. The UPDATED audit tool can be used to evaluate milestone-specific performance in a manner that can provide timely summative and formative feedback as well as promote resident reflection on performance and facilitate transfer of knowledge into clinical practice. The intended examinee audience for the audit tool is PGY-1 resident trainees who are rotating on inpatient ward rotations in internal medicine. This population was selected because PGY1 residents are the most common senders and receivers of patient handoffs, and they are typically responsible for completing the signout documents that accompany those handoffs. Methods The UPDATED tool assesses skills inherent the in the internal medicine EPA #8 (i.e., manage transitions of care). Several ACGME internal medicine milestones are addressed within this EPA, including ensuring appropriate and accurate documentation, appropriate synthesis and definition of clinical problems, and effective communication during transitions of care. The tool incorporates a points system to create an overall signout score, which is used to reflect overall achievement of competence. This resource includes a slide set to educate residents on the UPDATED criteria as well as a facilitator guide for instructors using the slide set. This resource also includes the paper-based UPDATED tool, and an auditor training guide. Results From April through July 2011, workshops to introduce the tool were held at three Chicago area teaching hospitals for a total of 130 participants (62% senior medical students, 38% internal medicine and family medicine residents). Participants felt more confident in creating a written signout (95%), and reported that auditing a written signout was helpful (93%). Many also thought the UPDATED framework was helpful (85%). After the workshop, almost all learners reported a commitment to change their practice. Learners described the workshop as “very practical” and felt “able to implement skills learned without much difficulty.” At one institution (The University of Chicago), the UPDATED audit tool was successfully piloted in academic year 2012-2013 as a formal assessment of signouts done by all 45 internal medicine interns on noncritical care internal medicine ward rotations. The workshop was associated with a significant improvement in actual signout quality in that only 13% of signouts audited received “good” scores prior to implementation compared to 73% receiving “good” scores following implementation (p < 0.001). Discussion Our experience during the pilot period of 2012-2013 demonstrated that the UPDATED tool is a feasible and effective way for residency programs to address resident achievement of competency in ACGME milestones related to handoffs. The tool was easy to use and required minimal training for auditors unfamiliar with it. This tool is easily adaptable to outside institutions seeking milestones-based tools for assessing signout communication skills.
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