Clinician sign-out A sign-out application can be created from laboratory and pharmacy transactions as well as Admission/Discharge/Tranfer (ADT) transactions at the various interfaces and then directing a copy to a temporary data base that uses PHP to format data for a web front end. The front end application allows user input into editable fields. The resulting presentation can then be made available (password protected, of course) across the enterprise to all residents. The system allows patients to be assigned to one or more roles, positions, or teams creating a census (e.g. team I, intern 1 or nightfloat) Here is an example screen print.
Some organizations keep all previous sign-out data on line to help pre-populate new records for patients who are frequently admitted.
An interesting by-product of the sign-out application is that the residents have found it convienent to use a templated print of a patient's sign-out record to serve as a daily progress note.
There is much debate about whether the information required in a clinician sign-out system should be included within the EMR. Here is one argument for why it should not be: While the discrete clinical data elements originate from the EMR, some of the other items that housestaff tend to want to communicate really should not be a part of the record; communications may range from "Patient complains of shortness of breath every night but always has normal SaO2, normal CXR, and normal EKG" (which may arguably belong in the record) to the more inflammatory "avoid going in the room when visitors are there; patient's family is a bunch of lunatics" (which clearly has no place in the record but is important to communicate - although there are more diplomatic ways to indicate the information, post-call surgical residents have little time for diplomacy!).