Implementation of a Standardized Pediatric Emergency Medicine Transfer of Care Sign-out Guide: A Feasibility Study

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This is a feasibility study to determine if a standardized transfer of care (TOC) sign-out guide for Pediatric Emergency Department (PED) patients improves resident satisfaction. Residents from various training programs (Emergency Medicine, Pediatrics, and Family Medicine) voluntarily reported their TOC sign-out satisfaction [100mm Visual Analog Scale (VAS)] and duration (minutes) preand post-implementation of a sign-out guide. Pre-intervention data collection occurred from September 2011 to January 2012, and post-intervention data collection occurred from February to May 2012. The guide included the following prompts: chief complaint, past medical history, history of present illness, admission reason, triage and final vital signs, pertinent positive and negative exam findings, and if applicable, medications, fluids, radiographic studies, consultant recommendations, and noted improvements (or lack of). A final section of the guide prompted the PED resident to ask if the receiving team had any questions. Resident satisfaction and TOC sign-out duration pre-and post-implementation of the sign-out guide were analyzed (n=292, 167 preand 125 post-implementation). Use of the sign-out guide improved resident satisfaction [Satisfaction (100mm VAS): Pre-implementation – 80 (95% Confidence Interval (CI) 70 – 83); Postimplementation – 95 (95% CI 87 – 99, p-value 0.02] without a statistically significant difference in sign-out duration [Duration: Pre-implementation – 5 minutes (95% CI 4.2 – 6.8); Post implementation – 5 minutes (95% CI 4.7– 5.8), p-value 0.3]. A standardized sign-out guide successfully allowed residents to convey important patient care information regarding TOC and improved resident satisfaction.