Resident Sign Out Deserves Great Design


In June 2014, Joyce Lee and Matthew Kenyon along with Pediatrics Chief Resident, Jennifer Zank and Stamps School of Art and Design Student, Xiaoying He spearheaded an effort to  revamp the resident sign-out process, which was conducted through Dr. Lee’s role as Emerging Technologies Chairwoman in the Department of Pediatrics.  Resident sign-out is the communication (both verbal and written) that occurs during shift changes (day to night and night to day) to ensure that patients are safely cared for in the hospital and interns at Mott Children's Hospital expressed frustration with the sign-out process.

The team used design thinking to better understand the sign-out process, using a variety of different methods including ethnography (“user” interviews with interns, senior residents and chief residents), they mapped out the current resident sign-out process and system, and they consulted with faculty from the school of Architecture (Joy Knoblauch). This slideshare shows the summary of their initial findings.

Based on the initial work and insights, the team elected to focus on improving the design of the written resident sign-out at Mott Children's Hospital in a two hour workshop.  Attendees included interns, senior residents, chief residents, the Pediatrics Chair Valerie Castle and the Director of the Residency Program Hillary Haftel, as well as faculty from the Schools of Art (Franc Nunoo-Quarco), Architecture (Joy Knoblauch), and Engineering (Amy Cohn). The multidisciplinary teams evaluated the current prototypes of the paper sign-out, identified information needs for the sign-out process and then quickly developed paper prototypes of signout forms that were more optimally designed to ensure communication of vital information, understanding of hierarchy for tasks of central importance and time-sensitive tasks, and mapping for awareness and understanding of the group of patients being cared for.

To build on the momentum from the workshop, residents will be working on further developing prototypes as part of their scholarly projects for residency, teaming up with design students to co-create the design. Feedback included:  

"The opportunity to collaborate with representatives outside of medicine allowed me to see how we can rethink how we approach patient hands offs and think 'outside the box.'"
"We are in an era of work compression for residents in this time of duty hour restrictions. With the increased number of hand offs we need to design creative solutions to ensure that information in not lost and the key data is conveyed. Working with collaborators from different departments allowed me to look at the problem with fresh eyes. The time for change in how we document and present critical patient information is now and the workshop showed me how we can be creative about our answers."

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