A Day in the Life

Sign Outs

Overview

While patients require medical care and attention at all hours of the day and night, the resident physicians caring for them obviously cannot be on duty 24 hours a day. In fact, duty hour restrictions limit how many hours residents can work in a week. When a resident leaves the hospital, he or she must turn over care of patients to another team; the process of communicating information about these patients is most commonly called “sign outs” or “hand offs.” Whichever term is used, it is critical that the team coming on duty receive complete and current information on the patients they will be caring for, including diagnoses, status, scheduled or required treatments and diagnostic tests, and any potential complications as well as recommendations on how to deal with them. Studies have shown that the failure to properly communicate information is one of the most common causes of serious medical errors.

SBAR-CQC

To facilitate the process of communicating critical information, programs have implemented a number of different sign out systems. One of the most common is the SBAR-CQC system. In this system, the team going off duty enters relevant information for all of its patients onto a standard form, which is then shared with the receiving team during a concise face-to-face sign out meeting. Each letter in the SBAR-CQC acronym represents one of the important elements of the sign outs:

Situation – a general introduction to the patient including his/her name, age, gender, condition, and a brief history of the present illness.

Background – includes the past medical history and any significant background information that has importance to the patient’s ongoing treatment and current status.

Assessment – includes the working diagnoses; problem list for that patient with current plan for each problem; anticipated course over the next 24 hours; and potential complications or problems.

Recommendations – describes the treatment regimens to be continued; studies to be ordered or monitored; and responses for potential complications or problems.

Code status – indicates whether, in the event of sudden cardiac arrest, resuscitation of the patient should be attempted. “Full code” means all resuscitative efforts should be aggressively pursued. “Do Not Resuscitate,” often abbreviated as DNR, means no resuscitative efforts should be initiated, usually in patients with terminal illnesses.

Questions – reminder for receiving team to ask any questions.

Contacts – emergency contact information for family members.

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