73. The Value and Pitfalls of Signout Culture with Mike Weinstock, MD
Mar 6, 2022
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Mike Weinstock, MD discusses the value of signout culture in healthcare, including its benefits for patient safety and career longevity. Topics covered include the pitfalls of signouts, the importance of prioritizing patient care and documentation, utilizing checklists, handoffs in emergency medicine, consequences of inefficient systems in the ER, rare cases, and the significance of clear communication and collaboration in signout practices.
Effective handoffs are crucial for patient safety and continuity of care, emphasizing the need for a clear sign-out culture and standardized procedures.
Taking ownership of a patient during a handoff improves patient outcomes and should include consistent procedures and effective communication.
Standardized handoff procedures, like the I-PASS method, enhance communication, reduce errors, and improve patient safety during transitions of care.
Deep dives
The Importance of Handoffs in Patient Care
Handoffs refer to the process of transitioning patient care from one healthcare provider to another. The podcast episode emphasizes the significance of effective handoffs in ensuring patient safety and continuity of care. It highlights the need for a clear sign-out culture where healthcare providers take ownership of their patients and responsibly transfer their care to incoming providers. By standardizing the handoff process and implementing tools like the I-PASS method, healthcare organizations can minimize errors, improve communication, and enhance patient outcomes. The episode also discusses the challenges and benefits of signing out patients, emphasizing the importance of self-care and preventing burnout among healthcare providers.
The Value of Taking Ownership in Handoffs
Taking ownership of a patient during a handoff is crucial for providing quality care. The episode highlights the benefits of physicians receiving patients before their shift ends, allowing them to start necessary workups and make critical decisions. By actively participating in the handoff process and acknowledging the responsibility for the patient's well-being, healthcare providers can ensure a smooth transition of care and reduce the risk of adverse events. The importance of standardized handoff procedures and the use of tools like I-PASS are also discussed, emphasizing the need for consistency and effective communication during the handoff process.
Implementing Standardized Handoff Procedures
Standardized handoff procedures, such as the I-PASS method, have shown positive outcomes in patient care. The episode encourages healthcare organizations to adopt these standardized procedures to enhance communication, reduce errors, and improve patient safety during handoffs. By following a structured approach, healthcare providers can efficiently transfer patient information, ensure important details are not omitted, and maintain continuity of care. The necessity of a consistent sign-out culture and collaboration within healthcare teams is emphasized, as it enhances the effectiveness and efficiency of handoffs.
Balancing Patient Care and Personal Wellness
The episode stresses the importance of balancing patient care with personal wellness. It acknowledges that practicing self-care and setting boundaries is crucial for healthcare providers to deliver quality care and prevent burnout. Encouraging a culture of support, teamwork, and assistance during handoffs can contribute to improved well-being and job satisfaction among healthcare providers. By addressing the importance of self-care and implementing strategies to support healthcare providers, organizations can promote a healthier work environment and improve overall patient outcomes.
Striving for Excellence in Patient Handoffs
The podcast emphasizes the need for healthcare providers to strive for excellence in patient handoffs. It advocates for a culture of accountability, effective communication, and a shared commitment to patient safety during transitions of care. Encouraging healthcare providers to take ownership of their patients and actively participate in handoffs can result in better patient outcomes and a more efficient healthcare system. The episode concludes by highlighting the value of implementing standardized handoff procedures and fostering a supportive environment for healthcare providers to ensure the delivery of high-quality care.
There is no doubt that handing over care of a patient to another clinician is potentially fraught with peril. After all, it’s in the transitional moments when error is most likely to occur. But there’s a balance to strike here because there are also myriad upsides to signouts for both the patient and clinician. In this episode, Mike Weinstock, MD breaks down the arguments in favor of signouts, how to do them well, the big fat hairy signout pitfall, and why signouts might just be a key ingredient to career longevity and patient safety.
Guest Bio: Mike Weinstock, MD is Professor of Emergency Medicine, adjunct in the Department of Emergency Medicine of The Ohio State University’s College of Medicine, and director of research and CME at the Adena Hospital.
He has lectured nationally and internationally on medical topics and patient safety issues and is the executive editor for UC RAP, contributed to ERcast and Risk Management Monthly, and has published original research in JAMA IM and Annals of Emergency Medicine. He is the author of the Bouncebacks! series of books,and How’d it Go?. Mike has practiced medicine nationally and internationally including volunteer work in Papua New Guinea, Nepal, and the West Indies.
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For full show notes of this episode and all sorts of other goodies, visit our podcast website
We discuss:
How the key to protecting yourself medico-legally is having your primary concern be about patient safety and then documenting such that the chart reflects good medical care [01:50];
Principles of medically defensible charting [05:00];
Rob’s chest pain template medical decision-making (MDM) [08:30];
The importance of remembering that one-directional rules (like PERC for PE) do not obligate you to do a workup if a patient fails the rule [12:00];
Why handing off a patient to the incoming doctor when your shift is over may contribute to a successful career as an emergency physician [13:00];
Whether your level of busy-ness during an ED shift is seen as an extenuating circumstance by a defense or plaintiff’s attorney [18:45];
An argument for always reviewing nursing/paramedic notes (and documenting that you did it) and trying to greet EMS when they arrive with a new patient [24:45];
Mike’s opinion of the ideal sign-out culture [32:00];
Some doctors are not comfortable signing out patients, but they take a risk in their career longevity by not doing so [35:30];
Why sign-outs need to have constraints [39:25];
More.
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