MD Sign-Out Tool

Medical Informatics


When patients are transferred to and from the care of care cross-covering, emergency, or nighttime house-staff, the Sign-out Tool is used by the exiting physician to leave detailed information about each patient for the oncoming staff. The Sign-out Tool organizes patients by team, and provides up-to-date information needed to understand patient context, make decisions and continue the treatment plan.


Cross-covering physicians are often required to make decisions about the treatment of a patient for whom they have not been the primary provider. Similarly, primary providers may need to know what happened to a patient overnight or while under another’s care. Patient charts are difficult to locate, and as with the EHR, they are frequently void of documentation on the patient’s ongoing issues and care plan. Likewise, a face-to-face verbal handover at shift change is not always possible. This leaves the on-call staff ill equipped to care for the patient.

Historically at UHN, to fill this gap team members sent email updates or used shared spreadsheets on centrally located computers to pass along information. Or, in some cases no written mechanisms were used at all. This use of email or shared documents jeopardizes privacy/confidentiality of patient health information, and also creates a workflow bottleneck where only one individual from the team can update the list at any time. And in the latter case, a complete deficit of handover information could result in failed attempts to call to the off-shift caregiver and/or decisions made without the necessary context.

In response to these issues, a web-based Sign-out Tool was developed.


  • It is web based and can be accessed from within the hospital and from outside by a VPN connection
  • Patient demographics are automatically synchronized with the EHR, avoiding duplication of data entry
  • Fields encapsulate the accepted standard for handover, otherwise known as SBAR (Situation, Background, Assessment, Recommendations)
  • Critical notes show up in bold for the on-call staff
  • The list can be printed for use on medical rounds
  • It can be accessed by multiple people simultaneously

Future expansion: Critical information is frequently not transmitted between health professionals who are treating the same patient. The Sign-out Tool platform is being expanded to create an inter-professional tool for communication between physicians, nurses, and allied health professionals.

Project Team

Tim Tripp

Melinda Hamill

Yuri Belan

Anatoliy Romanko