Sign out tools
Background
- In Emergency Medicine, we sign out very frequently relative to other fields.
- Sign outs are common sources of preventable errors.
- Many structured approaches to sign out have been developed.
- Some of those structures have been studied and found to decrease preventable errors in sign out.
Procedure
I-PASS mnemonic
Developed and validated in the pediatric field
Illness severity
Clearly state how sick the patient is now and anticipated trajectory (e.g., “Stable, but at risk for deterioration due to sepsis—on fluids and antibiotics, monitoring closely.”)
Patient summary
Briefly describe patient presentation, key findings, diagnostics, working diagnosis, current treatment (e.g., “72-year-old with chest pain; EKG non-ischemic, troponin pending; likely unstable angina vs NSTEMI — given ASA.”)
Action list
Provide next tasks to be done with responsible parties & timing (e.g., “Follow up second troponin at 21:30, reassess pain, arrange cardiology consult if elevated, prepare for admission if positive.”)
Situation awareness and contingency planning
Identify potential changes and what to do if they occur (e.g., “If pain recurs or EKG changes, page CT surgery urgently; if troponin negative but persistent symptoms, consider CT PE depending on risk factors.”)
Synthesis by receiver
Receiver reads back plan and clarifies ambiguities (e.g., “Stable chest pain, pending troponin at 21:30; if positive, admit to cardiology; if negative and asymptomatic, consider discharge with outpatient follow-up—will reassess after labs.”)
See Also
External Links
References
- Amy J. Starmer, Nancy D. Spector, Rajendu Srivastava, April D. Allen, Christopher P. Landrigan, Theodore C. Sectish, the I-PASS Study Group. I-PASS, a Mnemonic to Standardize Verbal Handoffs.Pediatrics
February 2012, VOLUME 129 / ISSUE 2 [[Category:Category:Misc/General}}