A qualitative study of sign-out processes between primary and on-call residents: Relationships in information exchange, responsibility and accountability

Objective: To review a quality improvement event on the process of sign-outs between the primary and on-call residents. Design: A retrospective qualitative study using semi-structured interviews. Setting: A tertiary academic medical center in Singapore with 283 inpatient Medicine beds served by 28 consultants, 29 registrars, 45 residents and 30 interns during the day but 5 residents and 3 interns at night. Participants: Residents, registrars and consultants. Intervention: Quality improvement event on sign-out. Main outcome: Effectiveness of sign-out comprises exchange of patient information, professional responsibility and task accountability. Results: The following process of sign-outs was noted. Primary teams were accountable to the oncall resident by selecting at-risk patients and preparing contingency plans for sign-out. Structured information exchanged included patient history, active problems and plans of care. On-call residents took ownership of at-risk patients by actively asking questions during sign-out and reporting back the agreed care plan. On-call residents were accountable to the primary team by reporting back at-risk patients the next day. Conclusion: A structured information exchange at sign-out increased the on-call resident's ability to care for at-risk patients when it was supported by two-way transfers of responsibility and accountability.