Safer Sign Out Process for ED
Calvert ER Safety Initiative Getting “National Buzz”
A new approach, called Safer Sign Out, that was developed by Calvert Memorial Hospital and regional ER doctors to enhance the sharing of critical information during handoffs is getting “a lot of buzz nationally,” said Dr. Drew Fuller, assistant director of the CMH emergency department.
Fuller has been selected to present Safer Sign Out during the hot topics track at the Maryland Patient Safety Conference on April 5. This will be followed by a panel discussion including Fuller and physicians from Washington Adventist, Medstar Montgomery Medical Center and Civista Medical Center.
“Breakdowns in communication are one of the leading causes of medical errors,” Fuller explained, “that is why having a standardized system is vital to ensuring continuity of care and patient safety.” Last year, the CMH emergency department treated over 41,500 patients.
Fuller is also strategic coordinator for patient safety at Emergency Medicine Associates (EMA). The largest provider of emergency services in our region, EMA staffs 12 emergency departments in northern Virginia and Maryland, including Calvert, Sibley Memorial Hospital and Washington Adventist Hospital.
According to Fuller, the Safer Sign Out process was initially created at Calvert Memorial for physician handoffs – the transfer of a patient from one provider to another – at shift changes. “It has since become the standard practice used by EMA system wide,” he said, “and is now featured on the American College of Emergency Physicians’ website and will be a critical tool offered nationally by the Emergency Medicine Patient Safety Foundation later this month.”
Fuller said the Safer Sign Out model provides a consistent way of handling these transfers that we hope will lead to a new national standard. He emphasized that the process is based on established evidence as well as expert consensus and clinician feedback.
“Basically, it boils down to five key steps,” he said. “We call these the 5 Rs – record, review, round, relay and receive feedback.”
During the record phase, the physician uses a sign out form as a safety checklist to identify any pending items or potential safety issues. Then both physicians sit down together, ideally at a computer, where there is access to laboratory and radiological results, to discuss the patient and assure a mutual understanding. This is followed by both of them making a bedside round together. At this time, the new physician is introduced and the patient’s status is updated. Sharing the transfer information with the nursing team is another key component. The final step is to receive feedback on the outcome.
Calvert Memorial Hospital and regional ER doctors developed “Safer Sign Out” as a way to enhance the sharing of critical information during handoffs – the transfer of a patient from one provider to another.