Home Handoffs/Transfers It’s all about the signout

It’s all about the signout

March 2014

Published in the March 2014 issue of Today’s Hospitalist

ON A SLOW NIGHT WHILE HE WAS ON-CALL IN 2005, Daniel Rosenthal, MD, MSc, MPH, tackled a chronic problem he shared with his fellow residents: the lack of any structured tool for the all-important handoff.

“We used multiple spreadsheets on shared drives, which people couldn’t access unless they were on a particular computer,” says Dr. Rosenthal. “I put together a database that standardized signout and pulled together our team census.”

The use of that database “which he named WardManager “”spread to the entire hospital.” And when his colleagues left residency and wanted to take the structured handoff application with them, he built the program out, making it HIPAA-secure, cloud-based and collaborative. Today, WardManager has 10,000 users.

Over the years, WardManager has added functionality: Users can buy subscriptions with EHR integration, charge capture and progress notes. The basic subscription includes a mobile platform; auto-day tracking for central lines, Foleys and medications; readmission memory; patient smart-tagging; single-click patient transfers; and a chief dashboard for analytics and quick redistribution of patients across teams.

“But we’ve kept our focus on signout,” says Dr. Rosenthal, now the director of healthcare intelligence at Inova Health System in Falls Church, Va. “We haven’t needed to pivot our strategy.”

WardManager’s signout feature, he adds, contains all the information doctors need for effective handoffs, including overnight to-do lists and the rounding census with discharge planning.

The signout can be printed for any single team member, the entire team or multiple teams, with signout and critical clinical information following patients transferred among shifts, teams and even care settings. The result, says Dr. Rosenthal, is a much safer handoff than hasty, unsecured e-mails between doctors or too-quick phone calls between on-calls and service blocks.

While 20% of current users integrate the application with their EHR, the rest use WardManager as a standalone signout tool. That raises the question: Why hasn’t such a critical capability already been built into EHRs?

“We thought we’d have a lifespan of two years because EHR vendors would develop a slick signout, but they haven’t,” Dr. Rosenthal explains. Instead, EHR signouts are “piecemeal, clunky and often not available on mobile devices. Vendors don’t understand physician workflow and how we function as teams when it comes to signout.”

A controlled trial using WardManager at a large academic medical center and published in 2012 by BMJ Quality & Safety found that its use led to a 42% reduction in near misses.

While 60% of users are residents, 21% are attendings, with use typically spreading from internal or family medicine to pediatrics, surgery, OB-GYN and neurology.

And physicians being hammered by tortured IT rollouts appreciate that WardManager “can be up and running in 24 hours,” Dr. Rosenthal says. More information is online at www.wardmanager.com.