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A National Survey

Leora I. Horwitz, MD; Harlan M. Krumholz, MD, SM; Michael L. Green, MD, MSc; Stephen J. Huot, MD, PhD

Arch Intern Med. 2006;166:1173-1177.

Background  Transfer of responsibility for patient care between physicians is a key process in the care of hospitalized patients. Systems of transfer management and transfer frequency may affect clinical outcomes.

Methods  To characterize the systems by which patient information is transferred ("signed out") between resident physicians in internal medicine residency programs and to determine the impact of recently enacted resident work-hour regulations on the frequency of transfers, we mailed a self-administered survey to chief residents at 324 accredited US internal medicine residency programs outside of New York State. The main outcome measures were sign-out practices, skills training, and transfer frequency.

Results  Surveys were returned from 202 programs (62%). Transfer systems varied among and within institutions: 55% did not consistently require both a written and an oral sign-out at transfers of care, 34% left sign-out to interns alone, and 59% had no means of informing nurses that a transfer had taken place. In addition, 60% of the programs did not provide any lectures or workshops on sign-out skills. After work-hour regulations were instituted, transfers of care for a hypothetical patient increased by a mean of 11% (from 7.0 to 7.8 transfers; P<.001) during a Monday-Friday hospitalization. A member of the primary team was in the hospital for 47% of the hospitalization.

Conclusion  Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.

Author Affiliations: VA Connecticut Healthcare System, West Haven (Dr Horwitz); and Robert Wood Johnson Clinical Scholars Program (Drs Horwitz and Krumholz) and Department of Internal Medicine (Drs Horwitz, Krumholz, Green, and Huot), Yale University School of Medicine, New Haven, Conn.

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