Who's covering our loved ones: Surprising barriers in the sign-out process

Mara B. Antonoff, Elizabeth A. Berdan, Varvara A. Kirchner, Tara C. Krosch, Christopher T. Holley, Michael A. Maddaus, Jonathan D'Cunha

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: The aims of this study were to characterize obstacles affecting current sign-out practices and to evaluate the potential impact of standardized sign-out guidelines. Methods: In June 2011, detailed guidelines for transitions of care were implemented, and a 29-item multiple-choice survey was developed to assess sign-out practices, attitudes, and barriers to effective communication. Surveys were administered to residents and nurses at 3 time points. Comparisons between time points were assessed using t tests and χ2 tests (α =.05). Results: Guideline implementation achieved nonsignificant improvements in satisfaction with sign-outs, perceptions of patient safety, adequacy of information provided in sign-out, and patient knowledge by on-call residents. On follow-up, concerns surfaced regarding less complete sign-out processes due to new duty-hour restrictions. Conclusions: Guideline implementation mildly improved perceptions of safety and adequacy of sign-out; however, persistent barriers to continuity of care remain. Sign-out standardization may not adequately ensure patient safety, and further efforts to improve handoff processes are in need.

Original languageEnglish (US)
Pages (from-to)77-84
Number of pages8
JournalAmerican journal of surgery
Issue number1
StatePublished - Jan 2013


  • Continuity of patient care
  • Education
  • Handoff
  • Handover
  • Residency
  • Sign-out
  • Surgery
  • Transition in care


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