Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

The ‘Sultan of Signout’

By Jeremy Samuel Faust, MD, MS, MA, FACEP | on August 1, 2013 | 0 Comment
Opinion
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

If you were a patient, would you want your case to be subject to a game of telephone between doctors? Probably not. But what if I asked the question this way: Would you like two doctors to think about your case or four?

You Might Also Like
  • Duty Hour Changes Won’t Change Resident Rotations
  • What’s in a name? Formality in the ED
  • Are shorter work hours for medical interns harming patients?
Explore This Issue
ACEP News: Vol 32 – No 08 – August 2013

In real life these pluses and minuses go together. Transitioning care from one team of doctors to another is an important part of our jobs as emergency medicine physicians. We all know this experience: Your shift is winding down. You are hurrying to dispo your long list of patients before time runs out. You don’t want to leave a mess behind for the fresh team of doctors coming to relieve you. The “network rules” fill your mind. ABC and CBS. “Always Be Closing” and “Close Before Signout.” As you rush to discharge a couple of patients, admit a few others, you come to the inescapable conclusion that you are going to have to sign out several of your patients to the next shift.

Oh, the shame! In baseball terms, this is akin to batting into the third out of the ninth inning and leaving runners on base. You had wanted to be the hero, ending the game with a base-clearing home run, just like that Hall of Fame legend Babe Ruth, the Sultan of Swat.

A good signout can also be a good consult – fresh eyes and ears from new doctors, often with different areas of expertise. A poor signout can be dangerous, more hole than cheese.

Now you’ve got a new goal: to get everything together and organize a smooth transition of care from one doctor to the next. You’re going to be the Sultan of Signout.

Most residents work on the active skill of signing out a patient to the oncoming team. But we don’t think about receiving sign out as a skill of its own. Instead we devote energy learning to better focus the presentations we give to others, providing the most important information and trying to leave out less important details.

Many use mnemonic devices such as SBAR (Situation, Background, Assessment, Recommendations) to guide this. A good signout leaves the new team knowing who the patient is, why he or she came in, what has occurred so far, the current thinking, and the plan going forward.

Most of the time, the new doctor is scribbling down as much information as possible. Not me. When possible, I type a signout note as a progress note as the presenter is talking. I use an incomplete macro (which I wrote about previously in ACEP News) to organize my notes in real time. But other than good progress notes, are there other ways we can improve on the skill of taking signout when starting a new shift? Yes.

Pages: 1 2 3 | Single Page

Topics: Out of the HospitalPractice ManagementQualityResidentResident's Voice

Related

  • Can This Patient Leave Against Medical Advice?

    March 10, 2025 - 0 Comment
  • Emergency Physicians of the Sandwich Generation Face Unique Challenges

    March 10, 2025 - 0 Comment
  • Texas Hospitals Now Must Ask About Immigration Status

    March 10, 2025 - 0 Comment

Current Issue

ACEP Now: June 2025 (Digital)

Read More

About the Author

Jeremy Samuel Faust, MD, MS, MA, FACEP

Jeremy Samuel Faust, MD, MS, MA, FACEP, is Medical Editor in Chief of ACEP Now, an instructor at Harvard Medical School and an attending physician in department of emergency medicine at Brigham & Women’s Hospital in Boston. Follow him on twitter @JeremyFaust.

View this author's posts »

No Responses to “The ‘Sultan of Signout’”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603