The Impact of a Standardized Checklist on Transition of Care During Emergency Department Resident Physician Change of Shift

Abstract

Introduction: Transitions of patient care during physicians’ change of shift introduce the potential for critical information to be missed or distorted, resulting in possible morbidity. The Joint Commission, the Accreditation Council for Graduate Medical Education, and the Society of Hospital Medicine jointly encourage a structured format for patient care sign-out. This study’s objective was to examine the impact of a standardized checklist on the quality of emergency medicine (EM) resident physicians’ patient-care transition at shift change. Methods: Investigators developed a standardized sign-out checklist for EM residents to complete prior to sign out. This checklist included topics of diagnoses, patient-care tasks to do, patient disposition, admission team, and patient code status. Two EM attending physicians, the incoming and departing, assessed the quality of transitions of care at this shift change using a standardized assessment form. This form also assessed overall quality of sign-out using a visual analog scale (VAS), based on a 10-centimeter scale. For two months, we collected initial, status quo data (pre-checklist [PCL] cohort) followed by two months of residents using the checklist (post-checklist [CL] cohort). Results: We collected data for 77 days (July 1, 2015 – November 11, 2015), 38 days of status quo sign-out followed by 39 days of checklist utilization, comprised of 1,245 attending assessments. Global assessment of sign-out for the CL was 8 compared to 7.5 for the PCL. Aspects of transition of care that implementation of the sign-out checklist impacted included the following (reported as a frequency): “To Do” (PCL 84.3%, CL 97.8%); “Disposition” (PCL 97.2%, CL 99.4%); “Admit Team” (67.1%, CL 76.2%); and “Attending Add” (PCL 23.4%, CL 11.3%). Conclusion: Implementation of a sign-out checklist enhanced EM resident physician transition of care at shift end by increasing the frequency of discussion of critical tasks remaining for patient care, disposition status, and subjective assessment of quality of sign-out.