359 Assessment of Utilizing a Standardized Checklist on Length of Time for Resident Physician Sign Out and Attending Physician Grading Consistency

Abstract

Transitions of patient care during physicians’ change of shift introduce the potential for critical information to be missed or distorted, resulting in possible morbidity. Since 2009, the Joint Commission has encouraged improving transitions of care as a national safety goal. Our study sought to determine if utilization of a sign out checklist during emergency medicine (EM) resident transition of care affected the consistency of attending physician overall assessment and if the checklist changed length of time to sign out. This prospective study assessed EM residents’ transition of care during departmental group sign out. After institutional review board (IRB) approval, residents of varying post-graduate years transferred their patients’ care to the incoming physician team. For two months, residents gave their typical sign out (pre-checklist cohort, PCL). For the next two months, residents utilized a standardized sign out checklist (post checklist cohort, CL). The incoming and outgoing attending physicians would assess each resident sign out, and give an overall assessment using a visual analogue scale. Intraclass correlation coefficients (ICC) using a two-way mixed model were calculated to determine the association between the two attending physician grades. ICCs were calculated for the PCL and CL cohorts. The time was also recorded from first patient sign out to last. Continuous data are reported as medians, with separate Wilcoxon signed rank tests conducted as appropriate. Assessment of transition of care was performed for 77 days (38 days of status quo, 39 days utilizing a checklist). There were 548 assessments in the PCL cohort and 697 in the CL cohort. The ICC for PCL was 0.11 (95% confidence interval -0.18 to 0.32), which demonstrates poor consistency between attending physician graders. The ICC for CL was 0.56 (95% confidence interval 0.45 to 0.65), demonstrating a moderate consistency among attending physicians. Length of time for sign out in PCL cohort was 13 minutes, and in the CL cohort was 9 minutes. This finding was statistically significant, p = 0.03. Our study concludes that a checklist utilized during emergency medicine resident sign out improves the consistency of attending physician assessments. A standardized checklist decreases length of time to sign out with the checklist.