The purpose of this grant is to fund the research necessary to fully understand the impact of this sign-out tool on clinician workflow, quality of sign-out, and continuity of care. This information will inform exactly how Partners will move ahead with tools to improve handoffs in care (i.e., whether the prototype will be adapted further, adopted Partners wide, or abandoned in favor of other solutions). The investigators hypothesize that a web-based handoff tool improves provider satisfaction, the quality of written sign-outs, and measures of continuity of care compared with current handoff tools.

This study will attempt to answer the following questions:

1. What are the specific needs for clinical content among various clinical personnel (nurses, residents, and attendings) on different services at two different hospitals (MGH, BWH)?
2. How can IT support sign-out that facilitates interdisciplinary communication and yet preserves user-specific content among different clinical personnel?
3. Can a sign-out tool currently deployed at MGH be transferred to BWH using existing IT services and a minimum amount of local IS effort?
4. What will be the future needs of this tool so that it can fully access data from MetaVision once it is deployed?
5. How should the tool be further improved such that it optimizes user adoption, provider satisfaction and workflow, the quality of sign-out, and continuity of care?
6. Is it feasible for a future, refined version of this tool to be adopted across Partners acute care hospitals?

The study design is an observational, before-after pilot study. A multi-disciplinary steering committee and working group will be assembled to determine requirements and guide design in conjunction with HPM leadership, research staff, a Partners IS analyst, and MGH LCS personnel. The intervention will then be implemented on two services. Before and during implementation, several outcomes will be measured, including provider satisfaction and workflow, continuity of care, and quality of sign-out.

Deliverables will include the following:

1. Clinical and functional specifications for a new web-based sign-out tool
2. A prototype of the sign-out tool tested on 2 active clinical services, one each at MGH and BWH
3. A report of the impact of the tool on clinical care
4. Lessons learned regarding design and implementation that can be applied to more broad-based efforts
5. An update to the Sign-out White Paper with recommendations for action based on the results of this study The lessons learned will be applicable not only to Partners, but to other institutions (nationwide and worldwide) wishing to improve patient safety during handoffs in care.

Inclusion Criteria:

• All nurses, residents, PAs, and attendings on the two study services

Exclusion Criteria:

• Clinical staff not on study services within study period