As a resident, your ability to safely care for patients often depends on how well you capture and communicate information about them to colleagues. How do you make sure you’ve discussed the most pertinent patient details with the next resident on your shift? An easy-to-remember acronym can help you conduct highly effective verbal sign-outs.
During sign-outs, it’s not uncommon for residents to “start reading from the very first patient on their sign-out,” Vineet Arora, MD, said in a presentation about the art and science of handoffs. Dr. Arora is an academic hospitalist and associate professor at the University of Chicago Medicine, who specializes in improving the learning environment for medical trainees and the quality, safety and experience of care delivered to hospitalized adults.
But running through a litany of patient details in conversation won’t help your fellow residents learn the information they need to successfully care for your patients after your shift.
In fact, “by the time you get to the 10th patient, the receiver is not paying attention,” Dr. Arora said.
To avoid this, she said researchers have developed a simple acronym—SIGNOUT—to help residents identify the key patient information they should communicate with care members during sign-outs. Follow this quick checklist for the top details to cover the next time you discuss your patients with a colleague:
- S—Sick or DNR? Be sure to explain if your patient falls into either of these categories and offer and explain how.
Example: “Okay, this is Mr. Jones. He’s our sickest patient, and he’s full code.”
- I—Identifying data. This information specifically pertains to describing the patient’s identity and the main reason for their hospitalization, which you should be able to summarize for another resident in one clear, succinct sentence.
Example: “Mr. Jones is a 77-year-old gentleman with a right middle lobe pneumonia."
- G—General hospital. Offer a concise explanation of the patient’s overall hospital stay, particularly noting how long he or she has stayed in the hospital and key developments on their treatment.
Example: “Mr. Jones came in a week ago hypoxic and hypotensive but improved rapidly with IV levofloxacin.”
- N—News events of the day. Before handing your patient over to a colleague, ask yourself what the biggest events of the day were that impacted your patients and/or their treatment. Taking mental inventory of these events will help you identify the most timely background information to share during sign-out.
Example: “Today, Mr. Jones’ temperature spiked to 39.5 degree Celsius, and his white count bumped from eight to 14. His portable chest x-ray was improved from admission. We sent blood and urine cultures. Urinalysis was negative, but his IV site looked red, so we started Vanco.”
- O—Overall health status. This should give a clear snapshot description of your patient’s current health condition.
Example: “Right now, Mr. Jones is sitting at 98 percent on two liters NC and is afebrile.”
- U—Upcoming possibilities. Explain any potential situations that may impact your patient’s current health status and your plans to address them. When offering treatments or solutions, be sure to explain the rationale behind your plan, especially during emergencies.
Example: “If he becomes persistently febrile or starts to drops his pressures, start normal saline at 125 cc per hour and have a low threshold for calling the ICU to take a look at him because of possible sepsis.”
- T—Tasks to complete overnight. Discuss a clear action-item list of the patient tasks you’d like your colleague to complete and your rationale for these tasks.
Example: “I’d like you to look in on him around midnight and make sure his vitals and exam are unchanged. I don’t expect any blood culture results back tonight, so there is no need to follow those up.”
After you’ve discussed these items, also be sure to leave room for questions. This gives the listener a chance to actively engage, filling crucial knowledge gaps that may impact the patient’s treatment and help avoid medical errors.
Want more resident-friendly tips for your next rotation?
- Review these 5 tips for night shift success.
- Learn how to master patient hand-offs with these 7 expert pointers.
- Read advice from former residents on how they managed clinical challenges.
- Review the AMA’s Succeeding from Medical School to Practice guide, which features expert advice on clinical and non-clinical issues for residents. The guide also comes with a video library, packed with practical presentations such as this one on handoffs by physicians and other health care experts.