Feedback to achieve improved sign-out technique.

To maximize the quality of sign-out documents within the internal medicine residency, a quality improvement intervention was developed and implemented. Written sign-outs were collected from general medicine ward teams and graded using an 11-point checklist; in-person feedback was then given directly to the ward teams. Documentation of many of the 11 elements improved: mental status (22% to 66%, P < .0001), decisionality (40% to 66%, P < .0001), lab/test results (63% to 69%, P < .0001), level of acuity (34% to 50%, P < .0001), anticipatory guidance (69% to 82%, P < .0001), and future plans (35% to 38%, P < .0005). The use of vague language declined (41% to 26%, P < .0001). The mean total scores improved from 7.0 to 8.2 out of a possible 11 (P < .0001). As new house staff rotated onto the services, improvement over time was sustained with 1 feedback session per team, per month. Similar interventions could be made in other programs and other institutions.