73. The Value (and pitfalls) of Signout Culture with Mike Weinstock MD

There is no doubt that handing over care of a patient to another clinician is potentially fraught with peril. After all, it’s in the transitional moments when error is most likely to occur. But there’s a balance to strike here because there are also myriad upsides to signouts for both the patient and clinician. In this episode, Mike Weinstock, MD breaks down the arguments in favor of signouts, how to do them well, the big fat hairy signout pitfall, and why signouts might just be a key ingredient to career longevity and patient safety.

Guest Bio: Mike Weinstock, MD is Professor of Emergency Medicine, adjunct in the Department of Emergency Medicine of The Ohio State University’s College of Medicine, and director of research and CME at the Adena Hospital.

He has lectured nationally and internationally on medical topics and patient safety issues and is the executive editor for UC RAP, contributed to ERcast and Risk Management Monthly, and has published original research in JAMA IM and Annals of Emergency Medicine. He is the author of the Bouncebacks! series of books,and How’d it Go?. Mike has practiced medicine nationally and internationally including volunteer work in Papua New Guinea, Nepal, and the West Indies.

We discuss:

How the key to protecting yourself medico-legally is having your primary concern be about patient safety and then documenting such that the chart reflects good medical care [01:50];
Principles of medically defensible charting [05:00];
Rob’s chest pain template medical decision-making (MDM) [08:30];
The importance of remembering that one-directional rules (like PERC for PE) do not obligate you to do a workup if a patient fails the rule [12:00];
Why handing off a patient to the incoming doctor when your shift is over may contribute to a successful career as an emergency physician [13:00];
Whether your level of busy-ness during an ED shift is seen as an extenuating circumstance by a defense or plaintiff’s attorney [18:45];
An argument for always reviewing nursing/paramedic notes (and documenting that you did it) and trying to greet EMS when they arrive with a new patient [24:45];
Mike’s opinion of the ideal sign-out culture [32:00];
Some doctors are not comfortable signing out patients, but they take a risk in their career longevity by not doing so [35:30];
Why sign-outs need to have constraints [39:25];
More.