The impact of duty cycle workflow on sign-out practices: a qualitative study of an internal medicine residency program in Maryland, USA.
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ABSTRACT: Objectives
Although JCAHO requires a standardised approach to handoffs, and while many standardised protocols have been tested, sign-out practices continue to vary. We believe this is due to the variability in workflow during inpatient duty cycle. We investigate the impact of such workflows on intern sign-out practices.Design
We employed a prospective, grounded theory mixed-method design.Setting
The study was conducted at a residency programme in the mid-Atlantic USA. Two observers randomly evaluated three types of daily sign-outs for 1?week every 3?months from September 2013 to March 2014. The compliance of each observed behaviour to JCAHO's Handoff Communication Checklist was recorded.Participants
Thirty one interns conducting 134 patient sign-outs were observed randomly among the 52 in the programme.Results
In the 06:00 to 07:00 sign-back, the night-cover focused on providing information on overnight events to the day interns. In the 11:00 to 12:00 sign-out, the night-cover focused on transferring task accountability to a day-cover intern before departure. In the 20:00 to 21:00 sign-out, the day interns focused on transferring responsibility of their patients to a night-cover.Conclusion
Different sign-out periods had different emphases regarding information exchange, personal responsibility and task accountability. Sign-outs are context-specific, implying that across-the-board standardised sign-out protocols are likely to have limited efficacy and compliance. Standardisation may need to be relative to the specific type and purpose of each sign-out to be supported by interns.
SUBMITTER: Lee SH
PROVIDER: S-EPMC5566623 | biostudies-literature | 2017 May
REPOSITORIES: biostudies-literature
Publications
The impact of duty cycle workflow on sign-out practices: a qualitative study of an internal medicine residency program in Maryland, USA.
Lee Soo-Hoon SH Desai Sanjay V SV Phan Phillip H PH
BMJ open 20170509 5
<h4>Objectives</h4>Although JCAHO requires a standardised approach to handoffs, and while many standardised protocols have been tested, sign-out practices continue to vary. We believe this is due to the variability in workflow during inpatient duty cycle. We investigate the impact of such workflows on intern sign-out practices.<h4>Design</h4>We employed a prospective, grounded theory mixed-method design.<h4>Setting</h4>The study was conducted at a residency programme in the mid-Atlantic USA. Two ...[more]
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