Inpatient Handoff Curriculum: Case #3:
*** Please make sure you have completed case #2 first (this case builds off case #2) ***
Clinical scenario:
Same patient (Mrs. Jane Doe) … however you have a new role.
It's now 2 days later and you’ve changed services. You have just finished your week of night float. You are now the daytime intern for Mrs. Doe. You're getting near the end of the day (now hospital day #11) and you want to verbally signout to your night float colleague. The patient has shown signs of improvement since admission. Her presumed ischemic colitis is nearly resolved. Her pneumonia seems to be improving. Her alcohol withdrawal delirium from hospital day 3 has shown no signs of return. Her sundowning from day #9 has improved since you stopped the benzo's and cut back on her narcotics. She denies any fever, shortness of breath, chest pains or abdominal pains on rounds today. Her mental status was good this afternoon, in fact you had a long talk with her about discharge planning which you hope will be possible in the next 1-2 days. She remains weak and is struggling with ADL's and nutrition. You expect she will need a couple weeks at a subacute rehab facility to regain her strength.
Overall, your impression today is that Mrs. Doe is making steady progress. However, she remains frail, continues to have marginal vital signs (Tm 99, hr still 100), continues to have abnormal labs (wbc has plateaued at 14k), and she continues to be medically complex with multiple active problems requiring 15+ medications.
You sit down in a quiet room with your night float colleague. What would you say VERBALLY about this patient?
Remember the ground rules for a verbal signout:
• You are giving the night float intern a written copy of your signout (see below)... so not everything needs to be conveyed verbally.
• You have 4 other patients to discuss, it's 7PM, you’ve been here since 630AM and you'd like to get home.
• There's another intern in line behind you to sign-out their 5 patients.
• You need to balance brevity with patient safety.
