Signing Out

The Commure Pro Sign-Out™ application helps health care providers communicate when handing off care for a patient to other members of the care team during a shift change. Providers can enter sign-out notes and outstanding tasks or “to-do” lists associated with patient care. This information can be entered at admission, during rounds, or after a patient encounter. With Sign-Out, every team member can track what needs to be done - whether it’s checking admission labs, consulting a cardiologist, ordering a medication, or changing a dressing. This system facilitates provider communication, ensures faster and more efficient care, and eliminates redundant work. Some examples of common usage include:

• Sign-Out or transfer of care between providers: When providers go off-duty, they can use Sign-Out to provide information about outstanding tasks to the cross-covering physician who will provide interim care for their patients. Sign-Out helps ensure that this knowledge transfer is complete and goes smoothly.
• Patient discharge: When a patient is discharged, there is often a set of tasks that must be completed by the responsible provider, including writing discharge prescriptions, follow-up with the primary care physician, coordinating the disposition of the patient, ensuring appropriate documentation, and so on. Sign-Out helps to ensure that all of these items are accounted for and completed.
• Rounding and daily work: There are a variety of tasks that need to be completed in order to care for the patient on a daily basis. Usually, these are defined during admission, during rounding, or after seeing the patient. The tasks can include checking lab or test results, ordering lab tests or other tests, consulting a specialist, ordering medications, and so on. Sign-Out can be used to enter and track the status of all these items. The Sign-Out system is available via the Commure Pro Physician Portal™ and Desktop Charge Capture™ web applications (accessed via a desktop, tablet, or laptop PC) from which providers or administrators can view, enter, and edit sign-out data.

The Commure Pro Sign-Out application allows providers to perform the following tasks on the web:

• Enter or update basic patient information on the Sign-Out form, such as surgery dates or code status. Providers can also enter free-text comments in one or more scratchpad fields that are available on the Sign-Out form.
• Enter new tasks associated with Sign-Out.
• Make changes to tasks or mark tasks as complete.
• View sign-out details for an individual patient, or view a summary for many patients at once. This chapter discusses the daily usage of Sign-Out within the Physician Portal and Desktop Charge Capture web applications. Sign-out information consists of a sign-out form and possibly one or more tasks. This set of Sign-Out information is always associated with a department. A patient has only one set of sign-out data per department. For example, the Internal Medicine department and the Cardiology department can each have one set of sign-out information associated with the patient Molly Darr. Sign-out information entered directly on the web is immediately available to all users who have permission to view or edit it.

See the Commure Pro on Apple Help for information on how to use the Mobile Sign-Out™ application.

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Viewing Sign-Out Information for One Patient

Sign-out information can be broken into two categories of information: the sign-out form and the sign-out tasks. The sign-out form usually consists of several patient information fields and scratchpads (free-text comment areas). Depending upon the type of sign-out form displayed, one or more of these scratchpads might be available:

• Personal Scratchpad: a free-text comment area that allows an individual user to enter notes that only s/he can view.
• General Scratchpad: a free-text comment area that allows users to share comments about a patient.
• Departmental Notes: a free-text comment area that is made available on the Sign-Out Summary. Typically, this type of scratchpad is used for on-call information, such as provider contact information or patient handoff details. In addition, some forms can be configured to allow you to edit data attributes that have been grouped together in a single field on the sign-out form area.

The sign-out tasks are a set of one or more “to do” items that can be assigned to a patient. Options for viewing an individual patient’s sign-out information on the Physician Portal application are available via the Patient List tab, or any option that has a Details icon next to a patient name. You can also view an individual’s Sign-Out information by selecting them from the Sign-Out Summary tab. Follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click the Sign-Out display option.
3. The Department filter in the upper right corner of the Patient Data Display allows you to toggle between sign-out data for the different departments. The list of departments available to you is based on the Sign-Out View Access setting in your user profile. If you have access to view Sign-Out for only one department, the name of that department displays as a view-only field. If you have access to view Sign-Out for more than one department, select the department with the sign-out information you want to view.
   • In the title bar, a Sign Out Last Modified date and time is displayed. The date and time represent the last time a user entered or changed sign-out task or form data for this patient in the selected department. The name of the user who last modified the form or task may also be included. These are configurable at the department-level.
   • The top section of the Patient Data Display shows the sign-out form for the selected department. If you or another user have already entered data on the sign-out form or if the form pulls patient data, it is filled out. Otherwise it is blank. Please note that if the sign-out form is long, you may need to use the vertical scroll bar to see all of the fields. If configured, free-text field areas, known as scratchpads, are also displayed.

• The bottom section of the Patient Data Display shows the sign-out tasks for the selected department if tasks are enabled. If tasks are not enabled, this section does not display. For each task, the system displays the name of the provider in the Completed By column when a task has been completed (if incomplete, the box is unchecked and does not display the provider’s name), Priority (an exclamation mark indicates high priority), Task (description), Due Date (and time), Type (the type of task), as well as Edit and Delete icons. You can edit or delete a specific task item on this list by selecting its corresponding Edit or Delete icon located in the far right column. Tasks that are past due appear in red. If no tasks have been entered for the patient in this department, this area is blank.

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Filtering and Sorting Tasks on the Sign-Out Display

You can filter or sort the Tasks portion of the Sign-Out display to meet your needs.

• To change the order in which the tasks are listed, click on any column heading. For example, clicking on the Due Date heading sorts the tasks in ascending or descending order by due date. Likewise, clicking on the Red Alert heading column sorts the tasks by order of their importance or priority.
• To further refine the list by selecting only tasks of certain priority or status, click the Options button located at the bottom of the task display area.

In the Task Display Options dialog, check only those items that you wish to include in the task display area. Your choices are:

• Restrict to High Priority Only: By default, this box is unchecked, so that tasks of all priorities (both Normal and High) are displayed in the task display area. Check this box to view only those tasks that are High priority.
• Include Completed Tasks: By default, the display includes tasks that are incomplete and complete. Uncheck this box if you do not want to include the tasks that are already completed.
• Include Tasks with Future Due Dates: By default, tasks with any due date are shown in the display. This includes tasks with due dates of today, earlier than today, later than today, and those without any due date at all. Uncheck this box if you do not want to include tasks with a future due date.

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Entering or Editing Sign-Out Information

Sign-out information can be broken into two categories of information: the sign-out form and the sign-out tasks. The sign-out form usually consists of several patient information fields and a free-text comment area. The sign-out tasks are a set of one or more “to do” items that can be assigned to a patient. Options for entering or editing an individual patient’s sign-out information on the web application are available via the Patient List tab, or any option that has a Details icon next to a patient name as follows:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click the Sign-Out display option.
3. The Department filter in the upper right corner allows you to toggle between sign-out data for the different departments. If you have access to view Sign-Out for only one department, the name of that department displays as a view-only field. If you have access to view Sign-Out for more than one department, select the department for which you wish to enter or edit sign-out information.

The top section of the Patient Data Display now shows the sign-out form for the selected department, while the bottom section shows the sign-out tasks for the selected department.

4. Review the sign-out form and tasks. You have several options:
   • If the form is blank and there are no tasks, fill out the form and enter any necessary tasks. See:
     • Entering or Editing Information on the Sign-Out Form
     • Entering a Defined Sign-Out Task.
     • Creating a Free Text Task
   • If the form is already filled in and there are already tasks entered, and the information is more-or-less accurate, you can make any necessary changes (update the form information, add tasks, delete tasks, or mark tasks as completed). See:
     • Entering or Editing Information on the Sign-Out Form
     • Creating a Free Text Task
     • Editing, Deleting, or Marking Sign-Out Tasks as Completed
   • If the form is already filled in and there are already tasks entered, but the information is outdated or incorrect, you can click the Clear All button to delete all of the sign-out data for this department including any tasks and start from scratch. See Deleting Sign-Out Information for a Patient.

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Entering or Editing Information on the Sign-Out Form

Before entering or editing information on the sign-out form, follow Steps 1-3 in Entering or Editing Sign-Out Information, and then:

1. Click in any field in the form area and enter or edit the information.

The fields available on this form vary by department, but might include items such as fields for different types of providers, surgery dates, or code status. It usually also includes a large free-text field (or scratchpad) for comments or notes. For example, some sign-out forms might display a personal scratchpad where individual users can view, add, or edit their own patient care notes. Or, a general scratchpad might also be available where users within a department can share comments and general notes about a patient. In addition, some forms can also display a departmental scratchpad on the Sign-Out Summary where departmental users can view on-call and patient handoff notes about patients. The form may also include non-editable fields that display patient demographic or visit information (for example, date of birth, current visit date, active problems or allergies). Any information that is visit-based is selected from the patient’s “current” visit, as determined by a standard setting used in the Commure Pro system. Some sign-out forms may contain a variety of calculation fields, such as Post-op date (POD), number of days a patient has been taking a medication, and others. In addition, you might also view data attributes (such as, Line #/Line Date/Days or Medication/Start Date/End Date) that have been grouped into a single field. For example, to change one or more of the attributes for the medication, Coumadin, select the hypertext link to display the Edit screen. And then, update the information as needed.

2. When you are done entering/editing information into the fields, click the Save button at the bottom of the screen.

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Entering a Defined Sign-Out Task

When entering new tasks for a patient, you can select defined tasks from your department’s Task Picker list, or if you cannot find the task you need on that list, you can enter a free text task. To enter a sign-out task:

1. Follow Steps 1-3 in Entering or Editing Sign-Out Information, and then choose one of the following:
   • Click Add , located to the right of the Sign-Out display option. The Select Task(s) window displays unless you belong to more than one department, then the Select a Department dialog displays. Choose the department from the drop-down list, and then click OK to display the Select Task(s) window.
   • Click the Add Task button at the bottom of the Tasks section. The Select Task(s) window displays.
2. Select the tasks you want to add from the Select Tasks window as follows:

• If the Select Tasks window contains a simple list of tasks, click on a task on the left side of the screen to display the Edit Task dialog.
• If the Select Tasks window groups individual tasks under categories and subcategories, click on a category or subcategory to display a list of tasks within that category on the right side of the screen. When you find the specific task you want, click on it. The Edit Task dialog is displayed.

3. Enter the task information in the Edit Task window as follows:
   • Task: Edit or add to the description for the task.
   • High Priority: Check this box if the task should be assigned a high priority.
   • Status: Select a status of Incomplete or Complete.
   • Due Date & Time: If appropriate, enter a date and time by which this task should be completed. You may type a date using mm/dd/yyyy format, or select one using the Calendar icon. You may also enter a time using either the 12 or 24 hour clock (for example, either 18:30 or 6:30 p.m.). Please note that when you enter a time based on the 24 hour clock, it is automatically converted to the 12 hour format.
   • Type: Select the type that best describes this task. When done, click the Save button to add the information to the selected task.
   4. Repeat Step 2 and Step 3 above to select as many tasks as needed.
4. Click OK to add the task(s) to the Tasks section below the patient’s Sign-Out form.

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Creating a Free Text Task

If you want to create your own task, you can create it as follows:

1. Click the Create Free Text Task button from either of the following locations:
   • At the bottom of the Tasks section in the Sign-Out display option for the patient.
   • At the bottom of the Task Picker window which displays after you chose to add a task (see Entering a Defined Sign-Out Task).

The Edit Task window displays.

2. Enter the task information in the Edit Task window as follows:
   • Task: Enter a description for the task.
   • High Priority: Check this box if the task should be assigned a high priority.
   • Status: Select a status of Incomplete or Complete.
   • Due Date & Time: If appropriate, enter a date and time by which this task should be completed. You may type a date using mm/dd/yyyy format, or select one using the Calendar icon. You may also enter a time using either the 12 or 24 hour clock (for example, either 18:30 or 6:30 p.m.). Please note that when you enter a time based on the 24 hour clock, it is automatically converted to the 12 hour format.
   • Type: Select the type that best describes this task. When done, click the Save button, and the system re-displays the Patient List or Patient Data Display screen, listing the new task.
   3. Repeat the previous steps to add more free text tasks.

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Editing, Deleting, or Marking Sign-Out Tasks as Completed

All tasks are displayed in the patient’s task list at the bottom of the screen. If a task is overdue it will appear as red text. While viewing sign-out tasks for a patient, you can take a variety of actions:

• To mark a task as completed, simply click the Completion Status check box in the far left column of the corresponding task in the Tasks section at the bottom in the Sign-Out display option to place a check mark in it.
• To change any attribute of a task, select the Edit button located in the far right column of the corresponding task in the Tasks section at the bottom in the Sign-Out display option. When the system opens the Edit Task window, change the data item(s) in question, and then click Save.
• You can delete a task at any time, for any reason. Simply select Delete located in the far right column of the corresponding task in the Tasks section at the bottom in the Sign-Out display option

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Deleting Sign-Out Information for a Patient

At any time, you can delete all sign-out information for a particular patient in a particular department. You would normally do this if the information was inaccurate or out-dated. Please note that the Clear Sign-Out option deletes the information in the sign-out form and the sign-out tasks for the patient, for the department that is currently selected in the Department view filter. To delete sign-out data for a patient, follow Steps 1-4 in Entering or Editing Sign-Out Information, and then:

1. Click the Clear Sign-Out button located at the top of the Sign-Out display.

The system displays the following warning message: “Are you sure you want to clear the sign-out information and remove all the tasks for [department name]”

2. Click Yes to delete the sign-out data.
   Click No to exit without deleting.
3. Enter the updated data or tasks, see the following for more information:
   • Entering or Editing Information on the Sign-Out Form
   • Entering a Defined Sign-Out Task
   • Creating a Free Text Task

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Viewing a Summary of Sign-Out Information for All Patients

The Sign-Out Summary sub-tab, located under the Patient Summary main tab, displays a summary of sign-out information for many patients at once. This includes sign-out form data, incomplete sign-out tasks (completed tasks are not shown) with their due date and time in parentheses if available. Any overdue tasks are displayed as red text. For a provider, this option typically displays the provider’s full patient list, along with the sign-out details for all of those patients. For an administrator that has been granted access to this option (see Sign-Out Admin), it displays a broader range of patients and associated sign-out details, such as all patients with sign-out information for a particular department. As a result, administrators will see additional options that they can use to control the amount of data shown on the summary. These options are not typically available to providers and are noted as such in the section entitled Using the Selection Criteria on the Sign-Out Summary. While viewing the Sign-Out Summary, a provider or administrator may be able to immediately modify the sign-out details for a given patient. For example, providers may modify data on the form and/or the list of sign-out tasks. In addition, providers can select Departmental Notes icon at the top portion of the Sign-Out Summary to enter or edit information that typically describes patient handoff or on-call information shared among users in a department. Whether or not they are able to edit this information is dependent on the Sign-Out Create/Edit Access setting in their user profile.

Show Settings that control this feature

• Admin - User - Sign Out - Sign-Out Create/Edit Access

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Using the Selection Criteria on the Sign-Out Summary

The controls for managing the patients that are included on the Sign-Out Summary differ for providers and administrators, based on each user’s individual access rights. The controls for managing the patients that are included on the summary are as follows:

• Patient List drop-down: Controls the patient list that is currently active for the Sign-Out Summary tab. The drop-down displays all favorited patient lists which can be either a List, View, or Assignment (master and its sublists).
• Print : Click this icon to print a copy of the Sign-Out Summary. Directions for printing the Sign-Out Summary can be found in Printing the Sign-Out Summary.
• Manage: this drop-down list contains options for adding, removing, or manually registering patients. It also has options for finding and showing the properties of a patient list. All of these options are also found in the Patient List tab and are described in greater detail in Creating, Editing, Deleting Lists.
• My Patient List or My Department radio buttons: These radio buttons control the source from which a user can select patients to view and are available only if the Sign-Out Admin setting in the user’s profile is set to Yes. While typically this function is enabled for administrators who do not have a patient list, it may also be useful for providers who wish to see all patients who have been signed out within their department, regardless of their patient list.
  • My Patient List: This choice shows the sign-out details of only those patients on the user’s own patient list. If the user has access to view sign-out data in more than one department, then they can see their patient’s sign-out data in each of those departments by using the Department drop-down list.
  • My Department: This choice shows all patients who have sign-out data in a given department. If the user has access to view sign-out data in more than one department, then they can view sign-out information for any of those departments by using the Department drop-down list.
• Patient filter: This option further controls the patients that are currently displayed on the summary.
  • All Patients option: Select this option to show all patients that match the additional filter and list criteria for them to be displayed regardless of whether or not there is Sign-Out data entered.
  • Only Patients with Sign-Out check box: Select this option to show patients that match the additional filter and list criteria for them to be displayed and have sign-out data entered. This includes patients with or without incomplete sign-out tasks. View patients with sign-out data.
  • Only Patients with Incomplete Tasks: Show all patients that match the additional filter and criteria for them to be displayed and have at least one Incomplete sign-out task. If the patient only has completed tasks, they will not appear when this option is selected from the drop-down.

In addition, the following behaviors are present when you have chosen other filtering features (these options are only available for administrators with Sign-Out Admin privileges):

• When My Patient List is selected, and this option is checked, only those patients from your patient list who have sign-out data are included in the summary.
• When My Patient List is selected, and this option is not checked: all patients from your patient list are included in the summary, regardless of whether or not they have sign-out data.
• When My Department is selected, this option is automatically checked: all patients who have sign-out data in the selected department are included on the summary.
• Department filter: Specify a department in this selection list to filter the patients on the summary based upon the tasks associated with a specific department.
• Departmental Notes icon : Select this icon when you want to view or edit a general note about patient handoff or on-call information that is shared with other users in your department.

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Managing Sign-Out Details on the Sign-Out Summary

To manage the details on the Sign-Out Summary, follow the steps below.

1. Click on the Patient Summary tab, and then on the Sign-Out Summary sub-tab.
2. Select any of the options at the top of the window to control the amount, type, or format of the information you wish to display, as well as the patients for whom you wish to display it. Please refer to Using the Selection Criteria on the Sign-Out Summary.
3. Make edits, additions, or changes to the details of the Sign-Out summary as follows:
   • Change the sort order by clicking the Patient name or Location column header. The sort order that you choose remains selected the next time you access this option. By default, the summary is sorted by Patient name.
   • Select the Departmental Note icon (if available) to add a patient handoff or on-call information that will be shared with all users within your department.
   • Mark a task as complete by clicking on the checkbox next to the task.

• Edit the form information and/or the sign-out tasks by clicking on a patient row to select it and then clicking the Edit Sign-Out button at the bottom of the Summary screen. A window containing both the sign-out form and the sign-out tasks is displayed. This is identical to what you would see if you clicked the Sign-Out display option on the Patient List tab. From this option you can edit the information on the sign-out form, mark tasks as complete, add tasks, edit tasks, and delete tasks. See the following topics:
  • Entering or Editing Information on the Sign-Out Form
  • Entering a Defined Sign-Out Task
  • Creating a Free Text Task
  • Editing, Deleting, or Marking Sign-Out Tasks as Completed
  • Deleting Sign-Out Information for a Patient

4. Click the Actions button in the upper right corner to use other functionality. For example:
   • Select Write Note (if available) to launch the NoteWriter application. You can then add or edit clinical documentation related to patients directly from the Sign-Out Summary screen.
   • Add a charge by selecting Add Charge (if available). The Charge Transaction screen appears. Enter the appropriate charge information and then click Save to save the charges.

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Managing Visit Information from the Sign-Out Summary

Any user who has privileges to edit or reassign visits may do so from the Sign-Out Summary. You might edit a visit in order to add a discharge date, change the provider or medical service, or update the patient’s location. To edit a patient’s visit information:

1. Select a patient on the list, and then click the Edit Visit button located at the bottom left of the Sign-Out Summary screen.

The information associated with the patient’s current visit is displayed.

2. Click on the fields you want to edit and make your changes.
3. Click the Save button at the bottom of the window to save your work, or click Cancel to exit without saving.

Reassigning visits is a useful tool in managing patient care across shifts within a healthcare facility. For example, in an inpatient setting, a provider who is going off duty can reassign his patients to a new provider. To reassign a visit:

1. Select a patient on the list, and then select the Reassign Visit button located at the bottom left of the Sign-Out Summary screen.

The Reassign Visit(s) dialog box appears displaying a drop-down list for each kind of provider or service that can accept assignments.

2. Search for and select the appropriate provider and/or service.

You can assign patients to a scheduled provider, hospitalist, care manager, attending physician, or medical service group, depending on how your facility is organized. If you leave any field blank, it effectively removes the previous provider or service from the selected visit.

3. Click the OK button to reassign the patient visit to the selected provider and/or service.

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Printing the Sign-Out Summary

Any user with access to the Sign-Out Summary tab may print a copy of the report in PDF format. The patients included on the report, as well as the order in which they are sorted, mimic the report as it is currently displayed on the Sign-Out Summary tab. Therefore, if you apply any of the selection criteria at the top of the screen or change the sort order at the time you choose to print the summary, the resulting report respects those settings.

• The format of the printed report can be customized to suit your organization’s needs. Contact your customer support representative to implement any of these options: Apply bold text to Summary Notes labels.
• Remove column labels from the Sign-Out summary printed report for each department.
• If the user has sorted the summary by Location, the printed report can group the patients by location and also include a count of the number of patients per location. This requires a change to a configuration file.
• In order to save space on the Sign-Out Summary and its printed report, the rows containing the field labels can be removed, or the font size can be reduced, or data attributes can be grouped together. Each attribute within these groupings is separated by a forward slash. For example, Line #/Line Date/Days/Tube Date/Tube/Days. These are implemented via XML customizations. To print the Sign-Out Summary, follow the steps below.

1. Select the Patient Summary tab, and then the Sign-Out Summary sub-tab to access the Sign-Out Summary.
2. If desired, use any of the options at the top of the window to control the amount, type, sort order, or format of the information you wish to display.
3. Click Print located at the top right of the Sign-Out Summary.

A Select Patient screen appears.

4. Select all the patients that you want included in the report. You can multi-select two or more patients by clicking on each row, or Select All to include all patients on the report.
   Your patient selection is maintained for any subsequent reports that you need to print. You can opt at any time to either re-use or modify the previous patient selection.
5. Click the Print button.

The system displays either a standard Print dialog box or Print Preview window.

6. Click the Print button to print the report, or click the Cancel button to exit this screen without printing the report.