Secret to a good signout?

[MrBling]

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Whats the secret to a good signout?

As an intern, it seems like I can never get it right.. either its too long or too short and the attending has to add to it.

I realize there is an element of preference, but i'm still having trouble getting it down to where there is just enough info that people feel comfortable with the signout and have a solid direction to proceed in.

 

[Apollyon]

Chief complaint
Results
What is pending
Disposition

58 y/o male SOB, mild chest pain, strain on EKG, bedside troponin is negative, d-dimer is pending, but CT-angio is already ordered. Will need admission, no PMD. Medicine is capped.

If you don't have a plan, it WILL be evident. People will have to start over if you give them a lame sign out.

As to attendings adding on, that's just academics. Now that I'm community, I see how some of those folks would NOT cut it in PP - they have this need to "be somebody, and be important!", so you will NEVER be completely right.

 

[Koil Gugliemi]

the secret is having years of experience. That's the way to know what's important and what's not.

 

[roja]

CC
Significant pos/negatives
Pending
Dispo

If someone wants more, tell them. This gets key, crucial information and allows for more questions if needed.

 

[Arcan57]

I had a well-nuanced discussion of how to effectively give sign-out and the signs of poor sign-out (especially non-pertinent history or physical exam findings), but realized after I typed it out that it basically said what Apollyon said.

The only thing I would add is: if you just picked up a complex patient before shift change, don't try to act like you have a complete plan unless you do. It's better for everybody if you just give a brief impression (cc, sick or not sick), what you've ordered, and state that the patient needs to be seen as new. Obviously it's BS if you pull that on a patient that's been there 2-3 hours, but on appropriate patients it keeps your colleagues from hating you when they realize your plan sucks. And we've all had the feeling where someone gives you signout and the diagnosis(or disposition) is obvious, but the person signing out to you is too tired to realize it.

 

[AmoryBlaine]

There's really only 2 ways to sign out.

1) The patient is tucked in and you need to provide "if-then" scenarios i.e. if the CT shows stroke consult neurology, if not admit to medicine for AMS.

2) The patient is new, but you have ordered some stuff.


Keep this in mind when you're off service. You'll get all sorts of **** sign out from other interns with statements like "check their BP at 9pm," "follow up PM CBC," "follow up CT A/P." It all needs to be phrased as "if-then."

 

[BADMD]

There's really only 2 ways to sign out.

1) The patient is tucked in and you need to provide "if-then" scenarios i.e. if the CT shows stroke consult neurology, if not admit to medicine for AMS.

2) The patient is new, but you have ordered some stuff.


Keep this in mind when you're off service. You'll get all sorts of **** sign out from other interns with statements like "check their BP at 9pm," "follow up PM CBC," "follow up CT A/P." It all needs to be phrased as "if-then."

+1 on this

If you have to check it, get if-thens. Only on the rarest occasion should you get something nebulous. In those cases, if anything comes up unusual, you have to go see the patient yourself.