The Impact of Environmental Context on Intern Sign-Out Quality

Soo Hoon Lee, Christopher Terndrup, Phillip H. Phan, Sandra E. Zaeh, Kwame Atsina, Nicole Minkove, Sanjay V. Desai

Research output: Contribution to journalArticlepeer-review


Background Resident duty-hour restrictions have led to more sign-out transitions, increasing the potential for preventable harm. An unfavorable environment is expected to exacerbate sign-out risks to patient safety. Objective The aim of the study was to evaluate the impact of noise, interruptions, long sign-outs, and sign-outs exceeding allotted time on sign-out quality. Methods Eight trained observers evaluated 620 evening patient sign-outs between interns for 40 weeknights between February and April 2015 at a large internal medicine training program. Quality of sign-out was measured three ways: information quality, scores from the Handoff CEX Tool, and peer evaluations. Results Noise had no impact on information quality. Interruptions negatively affected information quality (-0.10 < r < -0.15, P < 0.001) and Handoff CEX quality scores (-0.11 < r < -0.26, P < 0.001). Long sign-outs taking more than 1 hour negatively affected sign-out quality (-0.09 < r < -0.23, P < 0.05). Sign-outs exceeding allotted time negatively impacted peer evaluations (-0.11 < r < -0.22, P < 0.001). Conclusions Interruptions, long sign-outs, and sign-outs exceeding allotted time were related to lower sign-out quality. Improving the environment to reduce interruptions and training interns to manage their time during sign-outs may improve sign-out quality.

Original languageEnglish (US)
Pages (from-to)304-306
Number of pages3
JournalJournal of patient safety
Issue number4
StatePublished - Dec 2020


  • interruptions
  • long sign-outs
  • noise
  • protected time
  • sign-out quality

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health


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