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Editor's Correspondence: COMMENTS AND OPINIONS

Editor's Correspondence: COMMENTS AND OPINIONS In reply We thank Bittner for his thoughtful comments about our article.1 Bittner wonders whether our results might vary by volume, patient population, day of the week, perceived experience, ability and personality of the participants, or other characteristics. We were unable to conduct any meaningful subgroup analyses owing to the relatively small number of adverse events in the study. It is notable, however, that many of the sign-out–related problems identified by residents were not related to acute illness but to routine matters for which information or understanding was insufficient. We thus suspect that sign-out–related problems such as these are endemic in every hospital setting. Further research would now be valuable to tease out the relative influence of volume, severity of illness, day of the week, individual experience, and other factors on sign-out quality. The teams participating in this study were representative of the general medicine teams at Yale–New Haven Hospital, New Haven, Connecticut; every team we approached agreed to participate. The intern/resident pairs on call remained constant during each round of taping. Finally, Bittner suggests that we might have asked subjects to fit sign-out–related problems into predefined categories. Since this study was one of the first of its kind, we did not have enough empirical evidence to define these categories a priori. Rather, we followed standard qualitative analytic procedures to inductively generate categories from the data.2 Further work can now be done to validate and/or extend our findings in other settings. Our expectation is that this study can now serve as a framework for those seeking to conduct more quantitative work in the future. Correspondence: Dr Horwitz, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 789 Howard Ave, New Haven, CT 06519 (leora.horwitz@yale.edu). References 1. Horwitz LIMoin TKrumholz HMWang LBradley EH Consequences of inadequate sign-out for patient care. Arch Intern Med 2008;168 (16) 1755- 1760PubMedGoogle ScholarCrossref 2. Glaser BGStrauss AL The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL Aldine1967; http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2009.86
Publisher site
See Article on Publisher Site

Abstract

In reply We thank Bittner for his thoughtful comments about our article.1 Bittner wonders whether our results might vary by volume, patient population, day of the week, perceived experience, ability and personality of the participants, or other characteristics. We were unable to conduct any meaningful subgroup analyses owing to the relatively small number of adverse events in the study. It is notable, however, that many of the sign-out–related problems identified by residents were not related to acute illness but to routine matters for which information or understanding was insufficient. We thus suspect that sign-out–related problems such as these are endemic in every hospital setting. Further research would now be valuable to tease out the relative influence of volume, severity of illness, day of the week, individual experience, and other factors on sign-out quality. The teams participating in this study were representative of the general medicine teams at Yale–New Haven Hospital, New Haven, Connecticut; every team we approached agreed to participate. The intern/resident pairs on call remained constant during each round of taping. Finally, Bittner suggests that we might have asked subjects to fit sign-out–related problems into predefined categories. Since this study was one of the first of its kind, we did not have enough empirical evidence to define these categories a priori. Rather, we followed standard qualitative analytic procedures to inductively generate categories from the data.2 Further work can now be done to validate and/or extend our findings in other settings. Our expectation is that this study can now serve as a framework for those seeking to conduct more quantitative work in the future. Correspondence: Dr Horwitz, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 789 Howard Ave, New Haven, CT 06519 (leora.horwitz@yale.edu). References 1. Horwitz LIMoin TKrumholz HMWang LBradley EH Consequences of inadequate sign-out for patient care. Arch Intern Med 2008;168 (16) 1755- 1760PubMedGoogle ScholarCrossref 2. Glaser BGStrauss AL The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL Aldine1967;

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 27, 2009

Keywords: outcomes research,internship and residency,personality,medical residencies,adverse event,taping procedure

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