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sign out card question???

Discussion in 'General Residency Issues' started by mpsheeha, Mar 4, 2007.

  1. mpsheeha

    mpsheeha IRISH 5+ Year Member

    May 28, 2004
    Bloominton, IN
    As a sub-I were are asked to signout patients. However, there is no universal signout form or card used. Anyone know a site where I can download a generic form to use with the "must have" info???? Thanks!
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  3. Hurricane

    Hurricane Senior Member 5+ Year Member

    Aug 14, 2005
    The Metroplex

    Best bet is to ask your resident what they want, as some places expect them to be really detailed, others not so much. I went to a med school that required a lot of detail, so now sketchy sign out cards are a big pet peeve of mine.

    At the very least, you should have the patient's identifying info at the top: name, medical record number, room number, team, your name and pager, and if you're a subI, your resident's name and pager.

    Then a one liner describing the patient - 48 y/o BM h/o DM2, GERD, CHF admitted for UGIB, GI to scope in AM.

    Usually these three things are at the bottom:
    code status: FC, DNR, etc.
    do they need the IV replaced if it falls out: IV+ or IV-
    do you want blood and urine cultures sent if they spike a temp: Cx+ or Cx-

    The rest is variable. Good cards will also have the meds and allergies listed, really good cards have the dosages.

    If you have things that need to be checked by the cross-cover, you can make a to-do list with checkboxes. But don't check out anything that can wait until morning, and don't check out anything without specifying what to do with the result. For example, "check labs" is unacceptable. Better checkout would be: "check 1800 lytes, replete K prn" or "check q6h H&H, transfuse if Hb < 8". (And if you expect a pt might be transfused, it is good etiquette to make sure the blood consent form is signed and in the chart before you leave.)

    It is also good form to give warnings for problems you anticipate might come up, such as:
    "pt w/ delirium, if called, prn haldol already written."

    It's not as complicated as it sounds. Just think what info you would want if you got called about this patient at 2AM and didn't have any info except what's on the card.
  4. GrandMasterB

    GrandMasterB Big Poppa Pump 7+ Year Member

    Apr 11, 2001
    Larry, Dallas
    i have been curious about this too- how long do you guys take to sign out a list at your program. who does the signout- the interns? the residents? someone else?

    i am a prelim in medicine at abusy community hospital and we take at most 3 minutes to sign out lists of 8-12 patients and the interns are responsible for the signout etc.
  5. Hurricane

    Hurricane Senior Member 5+ Year Member

    Aug 14, 2005
    The Metroplex
    Sign-outs are done by the interns (or sub-Is) both here and where I went to med school. Takes 1-5 minutes, depending on if there is a high-maintence pt that needs more detailed signout.

    One thing I liked about my med school that they don't do at my residency institution is that the night-float was always in the morning report room at 7AM for you to pick your cards back up. That way you got to hear firsthand details if something happened overnight, and since you got your cards back, it was worth it to make them good, since you could just revise them every day as needed. Here you only get your cards back if you happen to bump into the night float, so everyone makes crappy cards since you have to remake them every day.
  6. mpsheeha

    mpsheeha IRISH 5+ Year Member

    May 28, 2004
    Bloominton, IN
    Thanks for the help. Medfools does not have anything so I will be making my own.
  7. Mumpu

    Mumpu Burninator, MD 5+ Year Member

    Aug 1, 2004
    Signout is sabotage. I'm a signout freak, having been on the receiving end of rather poor communication (a favorite has to be getting a midnight call on a "NTD" patient with "Doctor, just wanted to let you know that Mr So-and-so's post-transfusion platelets are still 2").

    Fancy a landscape-oriented piece of paper with the smallest margins Word will let you do.

    Column 1: Patient info. Not including patient room number and COR status should be punished by caning. Don't make cross-cover look up where the patients are, and no one wants to fumble through the chart in a COR.

    Column 2: One-liner HPI, updated with the most recent thinking as you proceed with diagnosis/workup/treatment.

    Column 3: Meds. All of them, including PRNs, and up-to-date.

    Column 4: Active problems with updated status.

    Column 5: Honeydo's. Be specific about what you want done or waive the right to be pissed if you disagree with the overnight management. Leave room to write down lab results or anything else you want follow-up on.
  8. gutonc

    gutonc No Meat, No Treat Administrator Physician PhD 10+ Year Member

    Mar 6, 2005
    A fibrotic stroma
    Excellent (and pretty much what my sign-out sheet looks like) although I have an extra column for my To-Do list separate from X-cover stuff.

    I would only add one thing...ONE PAGE ONLY. I don't care how complicated your folks are, how many patients you have, etc. I already have to sort through 5-10 team sheets when I get paged in the middle of the night. If you now make me sort through 4 pages of sign-out I will be a very cranky intern. Okay, crankier.

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