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Abstract: PO1067

The Impact of Electronic Sign-Out Dot-Phrase and Simulation Exercises on Inpatient Nephrology Transitions of Care

Session Information

  • Educational Research
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 800 Educational Research


  • Alstott, James D., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Ramadorai, Anand K., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Alagusundaramoorthy, Sayee Sundar, University of Kentucky, Lexington, Kentucky, United States
  • Strennen, Samantha J., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Maursetter, Laura J., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Bhutani, Gauri, University of Wisconsin-Madison, Madison, Wisconsin, United States

A fellow-led QI project was initiated in 2018 after division surveys indicated a need for change in the ongoing division transitions of care (TOC) practice.


We developed a standardized “sign-out score” to objectively assess TOC on the EMR sign-out. We next developed and implemented a standardized electronic medical record (EMR) dot-phrase as our first QI intervention. Case-based simulation sessions highlighting TOC pearls were conducted as the second QI intervention. Pre- and Post-intervention data for sign-out score was evaluated.


A total of 647 patient EMR sign outs were assessed between 2018-2021. Overall sign-out accuracy score (0-2) significantly improved with QI interventions (pre-intervention mean 0.9 [ 95% CI: 0.9-1; N=298] to 1.6 post-dot phrase [1.5-1.6; N=220] to 1.7 post-simulation [1.6-1.8; N=129]; p<0.001). Table 1 provides details on the results of sign-out score. After adjustment for level of training, improvement in overall accuracy was independently associated with both dot-phrase (adjusted odds ratio (aOR) 7.6 [95% CI: 4.9-11.9]; p<0.001) and simulation (aOR 1.88 [1.1-3.16]; p=0.01). Although 2 sign-out score measures which were high performing pre-intervention worsened with dot-phrase implementation: anticipated changes and non-RRT management (aOR 0.15 [0.1-0.23]; p<0.001 and 0.07 [0.02-0.23]; p<0.001, respectively), improvement was seen following simulation (aOR 1.36 [0.84-2.2]; p=0.21 and 4.6 [1.74-14.5]; p=0.002).


A standardized EMR sign out dot-phrase and simulation exercises both improved the overall accuracy of TOC practiced for inpatient Nephrology consult service. The impact of dot-phrase alone on previously high performing TOC measures suggests the need for further optimization of dot-phrase and continuing simulation to enhance provider self-realization of important components of TOC.

Table1: Frequency of best possible “sign-out score” before and after QI interventions
Sign-out score measures:Pre- intervention
Post-dot phrase
Post- simulation
Overall p-value
Renal Diagnosis (% [N])14 (41)72 (159)90 (116)<0.001
Baseline serum creatinine (% [N])41 (123)81 (178)82 (106)<0.001
Renal replacement treatment (RRT) details (% [N])66 (112/170)80 (90/11289 (67/75)<0.001
Non-RRT treatment details (% [N])97 (83/86)67 (70/104)91 (51/56)<0.001
Overall accuracy (% [N])18 (55)67 (147)76 (98)<0.001
Anticipated Changes (% [N])67 (199)30 (66)35 (45)<0.001