73. The Value and Pitfalls of Signout Culture with Mike Weinstock, MD

There is no doubt that handing over care of a patient to another clinician is potentially fraught with peril. After all, it’s in the transitional moments when error is most likely to occur. But there’s a balance to strike here because there are also myriad upsides to signouts for both the patient and clinician. In this episode, Mike Weinstock, MD breaks down the arguments in favor of signouts, how to do them well, the big fat hairy signout pitfall,  and why signouts might just be a key ingredient to career longevity and patient safety. Guest Bio: Mike Weinstock, MD  is Professor of Emergency Medicine, adjunct in the Department of Emergency Medicine of The Ohio State University’s College of Medicine, and director of research and CME at the Adena Hospital. He has lectured nationally and internationally on medical topics and patient safety issues and is the executive editor for UC RAP, contributed to ERcast and Risk Management Monthly, and has published original research in JAMA IM and Annals of Emergency Medicine. He is the author of the Bouncebacks! series of books,and How’d it Go?. Mike has practiced medicine nationally and internationally including volunteer work in Papua New Guinea, Nepal, and the West Indies. Awake and Aware | Our 2024 Live Event Join us at Awake and Aware 2024, a transformative 3-day workshop from May 1st to 3rd in Bend, Oregon. Mitigate stress and stay cool under pressure. Create the mindset you want and lock it in. Limited slots. Website: Awakeandawarebend.com 16.25 Hours Category 1 AMA CME The Flameproof CourseThe hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets For full show notes of this episode and all sorts of other goodies, visit our podcast website We discuss: How the key to protecting yourself medico-legally is having your primary concern be about patient safety and then documenting such that the chart reflects good medical care [01:50];Principles of medically defensible charting [05:00];Rob’s chest pain template medical decision-making (MDM) [08:30];The importance of remembering that one-directional rules (like PERC for PE) do not obligate you to do a workup if a patient fails the rule [12:00];Why handing off a patient to the incoming doctor when your shift is over may contribute to a successful career as an emergency physician [13:00];Whether your level of busy-ness during an ED shift is seen as an extenuating circumstance by a defense or plaintiff’s attorney [18:45];An argument for always reviewing nursing/paramedic notes (and documenting that you did it) and trying to greet EMS when they arrive with a new patient [24:45];Mike’s opinion of the ideal sign-out culture [32:00]; Some doctors are not comfortable signing out patients, but they take a risk in their career longevity by not doing so [35:30];Why sign-outs need to have constraints [39:25];More.