Document Type

Conference Proceeding - Restricted Access

Publication Date


Publication Title

Academic Emergency Medicine


Background and Objectives: There has been an increasing focus on medical errors as a target for quality improvement in the last several decades. One source of these errors in the emergency department (ED) is patient sign out. Studies have shown the I-PASS sign out model to have a decrease in mortality in the inpatient setting. Our hypothesis is that a standardized note in the emergency medical record (EMR) based on the I-PASS model will improve perceived patient safety. Methods: We performed a retrospective study at a large community teaching hospital evaluating two surveys completed by emergency medicine providers before and 6 months after implementation of a standardized EMR sign out smart phrase based on the I-PASS model. The smart phrase is an easy to use computer function that shortcuts a form into the provider’s note. The survey asked questions about patient safety and used a 5-point Likert scale. The primary outcome was perceived patient safety change. Secondary outcomes looked at the perceived change in delineating tasks and creating a systematic approach during sign out. Results: A total of 24 residents and 22 attending physicians responded to the first survey and 15 residents and 19 attendings responded to the second survey. A Mann Whitney U test was used to evaluate the pre- and post-survey results between the residents and the attendings. Both attendings and residents significantly saw a perceived improvement in patient safety during their sign out process (residents p < 0.001, attendings p < 0.001). Additionally, attendings and residents thought the sign out phrase significantly improved their clarity of task delineation (residents p < 0.001, attendings p 0.019) and systematic approach (residents p 0.003, attendings p 0.005) to sign out. Conclusion: Our study of the use of a standardized EMR sign-out smart phrase demonstrated significant improvement in perceived patient safety when using the sign out phrase during sign out. Additionally, ED providers felt that their sign outs were more systematic and that they were able to easily hand off tasks to the next provider. This study was limited in being a single-center study and evaluating only perceived safety and not actual patient safety outcomes. An I-PASS-based smart phrase can significantly improve physician perception in patient safety during sign-out in the ED, possibly because physicians believe their task delineation and systematic approach significantly improved.




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Society for Academic Emergency Medicine Annual Meeting, Virtual, May 11-14, 2021.