Implementation of a Standard Verbal Sign-Out Template Improves Sign-Out Process in a Pediatric Intensive Care Unit

J Healthc Qual. 2015 Sep-Oct;37(5):267-76. doi: 10.1111/jhq.12056.


Sign-out of patient data at change of shifts is vulnerable to errors that impact patient safety. Although sign-outs are complex in intensive care units (ICU), a paucity of studies exists evaluating optimal ICU sign-out. Our prospective interventional study investigated the use of a standard verbal template in a Pediatric ICU to improve the sign-out process. We designed and validated a survey tool to measure 10 items of optimal sign-out. The survey and analysis of sign-out information exchanged was performed pre- and postintervention. Forty-eight clinicians participated, with a survey response rate of 88% and 81% in the pre- and postintervention phases, respectively. Seventy-nine percent clinicians identified the need for sign-out improvement. Clinician satisfaction with sign-out increased postintervention (preintervention survey scores: 3.26 (CI: 3.09-3.43), postintervention 3.9 (CI: 3.76-4.04) [p < .01]). Three scorers analyzed the verbal and written sign-out content with good inter-rater reliability. After the intervention, sign-out content revealed increased patient identification, background description, account of system-based clinical details [p = .001] and notation of clinical details, code status, and goals [p < .002]. Interruptions decreased [p = .04] without any change in sign-out duration [p = .86]. The standard verbal template improved clinician satisfaction with sign-out, augmented the amount of information transferred and decreased interruptions without increasing the duration of sign-out.

MeSH terms

  • Academic Medical Centers
  • Child
  • Continuity of Patient Care / organization & administration*
  • Continuity of Patient Care / standards*
  • Humans
  • Intensive Care Units, Pediatric / organization & administration*
  • Intensive Care Units, Pediatric / standards*
  • Medical Errors / prevention & control*
  • Prospective Studies
  • Quality Assurance, Health Care
  • Surveys and Questionnaires