Top 10 Most Annoying Cross Cover Sign-outs
(Just for review, sign-out was when the day teams handed their patients over to me for the night, along with a little blurb about the patient, what could possibly go wrong, and things that need to get done overnight.)
1. The "do my dirty work" sign-out
"I want you to check the cardiac enzymes."
"Okay. And what should I do if they're positive?"
"Hmm.... good question. I guess you should heparinize the patient."
"Okay, is he guaiac negative?"
"I didn't check."
"Damn it, are you signing out to me a rectal exam to do???"
2. The "be the bad guy" sign-out
"This patient is really drug-seeking. Try not to give him morphine."
Later that night...
"Doctor, Mr. K is asking for morphine."
"The team told me not to give it to him so no morphine."
"Doctor, Mr. K said, 'I want to talk to that doctor who won't give me morphine'."
"I'm not talking to him!"
"He said the team misunderstood--"
"Just give him 1 mg of morphine. I don't have time for this."
3. The "mission: impossible" sign-out
"Make sure this CT gets done."
How do you "make sure" a CT gets done? I tried calling the tech and the radiology resident (neither of whom were easy to reach) and all I got was a vague assurance that it would "probably be done that night". Then at 9PM, I ask the nurse to see if it was done. It wasn't. The reason? The patient refused. If I wanted to get it done, I'd have to go try to talk the patient into it, then fill out a new requisition form and have it faxed, then call the CT tech and explain why the CT was so emergent that it needed to be bumped up on the schedule. Guess whether that CT got done?
4. The "check this lab that I'm not going to order" sign-out
About a quarter of the labs I was asked to check on never seemed to get drawn. If it seemed like an important lab, I would go ahead and reorder it. But PM labs could get drawn any time during the evening, so I felt silly chasing down a random chem panel, especially when there weren't many instructions for what to do with it. By the time I feel absolutely sure that it was an actual oversight and not just a late lab, it seemed like it would make sense to just wait another 8 or so hours till the morning instead of sticking the patient twice.
5. The sign-out that assumes that I know more about the patient than the team does...
"If the patient has a fever above 101.5, you can consider switching the patient from cipro to zosyn."
"What do you mean, 'consider'? Consider based on what? Based on my many years of experience in infectious disease?"
"Well, if the patient...... uh, just switch them to zosyn if they have a fever."
6. The "wrong info" sign-out
The most common thing to go wrong was that the room number is wrong. This was annoying if I needed to go see the patient, but especially if they told me to look up a consult. I hated having to run all the way across the hospital to find a patient's chart and then discover the patient wasn't where they said he was.
One night I had a patient where they gave me the wrong med record number. That was awful, especially since they wanted me to follow up cardiac enzymes on the patient. I was beginning to get upset that they weren't coming back, when I noticed that the record number was wrong. Ugh. If they spelled the patient's name wrong too, I would have been in big trouble.
7. The "no instructions" sign-out
"Here, this intern gave me this sign-out to give to you. The only thing to do is check the CBC on this patient."
"And what should I do with the CBC? Why are they ordering it? What's the cut-off for transfusion?"
8. The absent sign-out
Several times one team just never signed out to me. This mad me really furious, because I was getting calls all night on patients I knew nothing about. This is almost criminal.
9. The "too much to do" sign-out
"Yeah, so I need you to follow up recs from cards, pulmonary, renal, and rheum on these five patients. Also, I need you to check enzymes and an EKG on this patient, then discharge him if they're negative... you also should go talk to the family and let them know the results, also you need to check a chem panel and CBC on every patient on my list, if this patient rules in, you need to heparinize him and call cardiology, and if this other patient has an abscess on his MRI, I need you to call neurosurgery and tell them to urgently make sure to see the patient."
10. The "five-page long" sign-out
"Sorry, I have a lot of patients... this is going to be painful."