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J Surg Educ. 2011 Jan-Feb;68(1):52-7. doi: 10.1016/j.jsurg.2010.09.001.

Template for success: using a resident-designed sign-out template in the handover of patient care.

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Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, Washington 98101, USA.



Report our implementation of a standardized handover process in a general surgery residency program.


The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System.


Nonprofit, tertiary referral teaching hospital.


General surgery residents, residency faculty, patient care providers, and hospital administration.


After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents.


The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures.

[Indexed for MEDLINE]

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