Using a Computerized Sign-Out System to Improve Physician-Nurse Communication

Background: Communication problems among health care workers are a common, preventable source of hospital-related morbidity and mortality. Internal medicine residents at Jacobi Medical Center (Bronx, NY) began using an electronic sign-out program that had been incorporated into the computerized medical record. This new system had been developed to improve the quality of information transfer between cross-covering residents. Eighteen months later, a pilot study was initiated to explore the potential benefits of offering inpatient nurses access to this sign-out data. Methods: Nursing staff members were provided electronic access to the residents' sign-out information. Nurses received printouts of the computerized signouts at the start of each shift and were asked to use the sign-out program as a basis for their care plans and nursing change-of-shift "report." Results: The 19 (of 20) nurses who completed the survey agreed that using the resident sign-out program positively affected their ability to care for their patients. In addition, the intervention improved nurses' understanding of the patients' reason for admission, helped to improve communication between physicians and nurses, and raised nursing morale. Discussion: Incorporation of a housestaff electronic sign-out system into nursing daily workflow demonstrated multiple benefits and facilitated the transfer of valuable patient information from housestaff to nurses.