Picture this: it’s 6:55 a.m., your coffee’s gone cold, and your brain is somewhere between night shift fog and daylight clarity. You glance at the board—half the patients are yours, half are new mysteries—and in strolls the incoming doc, fresh-faced and ready. Time for sign-out. In emergency medicine, handoffs aren’t just routine—they’re critical. The transition of care during shift change is one of the most vulnerable moments in the ED, where information can be lost, plans miscommunicated, and patient safety compromised. But with the right approach, sign-outs can be efficient and collaborative.
In this episode, Andy, Drew, and Tanner explore the nuances of the emergency department sign-out—because your shift may be over, but your responsibility isn’t, until the handoff is done right.
Why Sign-Outs Matter
Emergency medicine occurs 24/7, which means one team finishes what another started. A solid sign-out isn’t just about transferring responsibility—it’s about transferring context, clinical reasoning, and anticipation. A bad handoff can lead to duplicated work, missed diagnoses, or worse—harm to the patient.
Keys to an Effective Sign-Out
Be Mindful of the Environment: You want to create the most ideal environment for signing out. Decrease as many distractions and interruptions as possible. Treat signing out like a procedure.
Anticipate and Prioritize: Don’t wait until your shift is over to think about sign-out. Begin preparing early—consolidate the list, identify high-acuity or disposition-pending patients, and consider who’s stable and who’s simmering. Flag what needs active follow-up. Anticipate questions and be ready to give your colleagues the next steps on a silver platter. Make sure that your documentation is complete for the oncoming doc. It is crucial that they are able to understand your thought process up to the point that the patient is signed out.
Ownership and Accountability: Make sure the person receiving sign-out understands what they’re getting. Don’t pass along vague plans (“maybe dispo them later” or “might need labs”) without a clear sense of timing or action. The sign-out should end with “Here’s what you need to know and do”—not “Figure it out.”
Minimize “Turfing”: Resist the temptation to offload messy patients or tasks you just don’t feel like handling. Everyone’s tired at the end of a shift, but dropping unstable or undifferentiated patients on your colleagues without adequate context breeds resentment and jeopardizes care. Signing out tasks—especially procedures—should be the exception, not the norm. Passing off time-consuming or technically demanding interventions puts unnecessary strain on your colleagues, especially when you had the time (and energy) to get it done. That said, there are absolutely situations where signing out a procedure is understandable, like when the need for it was unexpected, or you’ve been delayed. If performing the procedure would significantly delay your leaving your shift on time, it’s reasonable to hand it off—as long as you give a clear sign-out and communicate the “why” behind the delay.
Communication is a Two-Way Street: The receiver of sign-out has a responsibility to be engaged too. Ask clarifying questions. Summarize key plans. If something doesn’t make sense—say so.
Take-Home Points
- Sign-out should be clear, concise, and clinically relevant.
- Don’t dump. Delegate thoughtfully.
- It takes two to sign out.
Post by Jordan Palmer, DO PGY-1
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