Sign Out Form

Emergency Dept, VAPAHCS

Sign Out Report

Emergency Department
VAPAHCS

Room Number:____________

Patient Name_______________________________ Last 4:___________________

Age:_______

Presenting Complaint:

Pertinent PMH:

Pertinent Vitals: HR__________ BP___________ RR___________ Temp___________

Physical exam findings:

Pertinent Labs:

EKG:

Diagnostic Imaging:

Diagnosis/Potential
Diagnosis:_____________________________________________________

Treatments/Plan:

Admission
team:________________________________________________________________

Name of
resident/attending/pager:_________________________________________________

Code status: Full code DNR

 Sign Out Form
Emergency Dept, VAPAHCS

1. ANY admission needs to be on the Sign Out Board, regardless of bed status.
(beds come and go, so we can never be sure a bed will stay available).

2. The Sign Out Sheet should be filled out as complete as possible, but not
everything on it needs to be filled out, only what you believe to be pertinent. The
items on the sheet are there to jog your memory and to assist you in giving a good
sign out to the oncoming doctor. Again, be as complete as possible.

3. Why can't we use CPRS computer notes?

Because the computer notes are incomplete, either not done or the notes are not
signed, and they are hard to access quickly. In addition the information you need is
either not charted or not put in one standard place, thus leading to searching a note
for information which is time consuming. The sign out board is immediately
available, easy to read, and gives a quick bird's eye summary of the patient,
treatment, code status, and contact information. It can be brought to the bedside
quickly. It is filled out by the admitting physician, the person who knew the patient
best. The Sign Out Sheet gives an outline to assist in a good sign out and serves as
a central place to store this vital information for reference later.

4. Why are we doing this?

We are correcting a dangerous time in Emergency Medicine, which is sign out time.
It is well documented that many mistakes occur during this time. We have had a
few mistakes recently in our own department. We have seen very poor sign out
information being passed along from physician to physician, with scraps of paper
notes lost from shift to shift. When queried about patients boarding in the ED, we
have heard physicians state: "I don't know anything about the patient other than he
is admitted to Medicine".

We will be holding more patients in the ED in the coming months as the flu season
hits and we sort out hospital flow problems. We have had as many as ten boarding
patients, and boarding times have been over 24 hours, crossing 3-4 shifts and 3-4
different physicians. Because of all the above, we have adopted a suggestion for a
sign out board. It's a great idea and one whose time is overdue. That's why we are
doing this.

5. Location of the Sign Out Board is on/near the orders sheet rack between where
the physicians sit.