Maryland Patient Safety Center

For more information about the “Safer SignOut” initiative, please contact:

Safer Sign Out Initiative

Supporting Physician Handoff Communication

Sign out can be one of the most dangerous procedures in your emergency department. The Maryland Patient Safety Center in coordination with the Emergency Medicine Patient Safety Foundation can help you implement and assess Safer Sign Out, a protocol for adding resilience to the physician handoff process.

What is “Safer Sign Out”?

“Safer Sign Out” is a patient-centered, team-based tool that provides a practical, efficient and tested methodology for structuring physician handoffs in emergency departments. It was developed by physicians for physicians to help reduce the risk of miscommunication, lapses or delays in care as a result of patient handoffs.

The Safer Sign Out process is becoming a national tool and is listed as a resource with the Emergency Medicine Patient Safety Foundation (, the American College of Emergency Physician’s Quality Improvement & Patient Safety Section, the American Medical Association (RFS) and the Agency for Healthcare Research & Quality (PSNet).

What Makes for a Safer Sign Out?

The key components of safer sign out are based on established scientific evidence as well as expert and clinician consensus for improving reliability in the handoff process. The Record, Review, Round, Relay and Receive Feedback structure utilizes tested methods to connect the transferring clinicians with each other, the patient and the nursing team.

Why “Safer Sign Out”?

Emergency departments are one of the most vulnerable areas in the healthcare system for errors. The stakes are high and The Joint Commission estimates that “Up to 80% of serious medical errors involve miscommunication during handoffs.” In addition, “Up to 24% of ED malpractice claims are related to a handoff issue” (Cheung, 2010).

Safer Sign Out was designed to help with:

  • Safety  –  Safer Sign Out was designed to focus on known areas of vulnerability
  • Reliability –  Structured communication methods are proven to reduce errors & lapses
  • Risk Reduction – Communication errors during handoff are a leading cause of harm
  • Teamwork  – Opportunity for the physician & nurse to share information
  • Patient Satisfaction – Patients appreciate being a part of the transition
  • Clinician Satisfaction – Clinicians appreciate a more reliable, efficient and structured process