Módulo Programas Médicos para el Sistema de Información Hospitalaria XAVIA HIS / Module Medical Programs for the XAVIA HIS Hospital Information System

La prestación personalizada de los servicios de salud resulta cada vez más atractiva y eficiente. El empleo de las herramientas informáticas para facilitar este propósito es una necesidad de las instituciones de salud. El Sistema de Información Hospitalaria XAVIA HIS es un ejemplo de la relación entre las necesidades de las instituciones de salud y la evolución funcional del mismo. Sin embargo, en el sistema no se ha concebido la posibilidad de planificar un protocolo que especifique los cuidados y procedimientos que deben realizarse en función del estado de salud del paciente. El trabajo presenta el desarrollo del módulo Programas Médicos para el sistema XAVIA HIS, que permite mejorar la gestión de la información generada durante el procesamiento de los programas médicos en las instituciones hospitalarias. Se realizó el análisis de los procesos de negocio asociados a la gestión de los programas médicos, se empleó como metodología de desarrollo AUP-UCI, JBoss Developer Studio, Java, JBoss como servidor de aplicaciones, PostgreSQL como sistema gestor de bases de datos y Visual Paradigm como herramienta CASE. Como resultado se obtuvo el módulo Programas médicos para el sistema XAVIA HIS, que permite la configuración de un programa médico a un paciente con una determinada enfermedad agrupando varios servicios, procedimientos, investigaciones clínicas por cada área del hospital(AU).

The health services personalized provision is becoming increasingly attractive and efficient. The computer tools used to facilitate this purpose is a necessity for health institutions. The Hospital Information System XAVIA HIS is an example of the relationship between the health institutions needs and its functional evolution. However, the system has not conceived the possibility of planning a protocol that specifies the care and procedures that must be performed depending on patient health condition. The paper presents the development of the Medical Programs module for the XAVIA HIS system, which allows to improve the management of information generated during the medical programs processing in hospital institutions. For this work development, an analysis of the business processes associated with the medical programs management was carried out; AUP-UCI was used as development methodology, JBoss Developer Studio, Java, JBoss as an application server, PostgreSQL as database management system and Visual Paradigm as a CASE tool. As a result, the Medical Programs module for the XAVIA HIS system was obtained, which allows the medical program configuration for a patient who has a certain disease, grouping several services, procedures, clinical investigations for each hospital area(AU)

Causation between Pathway Completion and Reduced Hospital Stay in Patients with Lung Cancer: a Retrospective Cohort Study Using Propensity Score Matching.

We have previously demonstrated that clinical pathway completion helps reduce hospital stays. However, our previous results showed only a correlation, not causation. Therefore, the current study's aim was to analyze the causation between clinical pathway completion and reduced hospital stays for patients with lung cancer. Data were collected from April 2013 to March 2018 from the electronic medical records of the University of Miyazaki Hospital. We used propensity score matching to extract records from 227 patients. Patients were further divided into a pathway completed group and a pathway not completed group; 74 patients in each group were available for data analysis. Our main analysis involved estimating the discharge curve, which was comprised of the in-hospital rate and hospital stay. Additional analyzes were performed to compare the frequency of medical treatments registered in the clinical pathway but not implemented (termed deviated medical treatments). The occurrence of these treatments meant that the clinical pathway was not completed. The main results indicated a decrease in the in-hospital rate of the completion group, compared with the not completed group. The p value of the log-rank test was <0.001 for total patients and patients who underwent resection, and 0.017 for patients who did not undergo resection. Additional results indicated that a number of intravenous drips were not implemented, despite their registration on clinical pathways. Our results indicate that clinical pathway completion contributes to improved efficiency and safety. This simplified procedure is expected to be applicable to other diseases and clinical indicators.

Surgical Data Recording Technology: A Solution to Address Medical Errors?

: Reducing preventable medical errors remains a universal goal, yet implementing effective solutions remains a challenge. The development of surgical data recording technology shows promise to generate robust qualitative and quantitative data in the surgical theater. These data can allow physicians and their teams to capture specific sources of error and implement corrective interventions. Surgical data recording technology encompasses rudimentary data tabulation on notecards, to integrated audio-video systems containing cameras, microphones, and sensors, capturing and synthesizing intraoperative, environmental, and instrumentation information, along with devices tailored to robotic surgical systems. There is growing interest in the implementation of such technology in medical centers, particularly in the United States, Canada, and Europe, but existing medicolegal and regulatory challenges necessitate further research and clinical assessment in order for this technology to facilitate improved surgical patient safety.

Wrong-Patient Blood Transfusion Error: Leveraging Technology to Overcome Human Error in Intraoperative Blood Component Administration.

BACKGROUND: Confirmation of match between patient and blood product remains a manual process in most operating rooms (ORs), and documentation of dual-signature verification remains paper based in most medical institutions. A sentinel event at Johns Hopkins Hospital in which a seriously ill patient undergoing an emergent surgical procedure was transfused with a unit of incompatible red blood cells that had been intended for another patient in an adjacent OR led the hospital to conduct a quality improvement project to improve the safety of intraoperative blood component transfusions. METHODS: A multidisciplinary quality improvement project team led a four-phase implementation of bedside bar code transfusion verification (BBTV) for intraoperative blood product administration. Manual random sample audits of blood component transfusions were used to examine accuracy of documentation from July 2014 through June 2016. After the transition to the Epic anesthesia information management system (AIMS) in July 2016, automated Epic reports were generated to provide population-level audits. RESULTS: After initiation of BBTV and the addition of Epic AIMS, compliance with obtaining three metrics on documentation of patient identification (two electronic signatures, start and stop times of transfusion, and blood volume transfused) was improved during a one-year period to > 96%. Pre-Epic audits had shown a mean compliance of only 86%, mainly reflecting a lack of paper blood component requisitions. CONCLUSION: By implementing BBTV and using a novel intraoperative documentation process within the Epic AIMS, a safer process of blood transfusion in the ORs was initiated and documentation improved.

Long-term experience with setup and implementation of an IHE-based image management and distribution system in intersectoral clinical routine.

PURPOSE: Sharing of medical data is crucial for the proper treatment of patients as it could reduce the risk of duplicated medical tests and speed up the care process if all documents are readily available. Despite great technical progress, sharing patient data while maintaining full control over the process in an intersectoral (in Germany, this describes the different actors in the healthcare system consisting of clinic, ambulatory care, etc.) setting remains a particular challenge. This paper focuses on the successful implementation of a privacy compliant, standards-based image-management component of a personal electronic health record. METHODS: Over a 5-year period, a sharing system based on readily available IHE profiles constructed around XDS has been built. It was necessary to create interfaces for the existing hospital sub-systems to become part of the network. Specifically, the imaging workflow had to be adapted to allow for fast and easy access to DICOM images utilizing a flexible web-based image viewer. In addition to the standard XDS workflow, an Imaging Cache was established which combines the Imaging Document Source and Consumer to guarantee fast and streaming-based access to all images in the network observing the high security standards of the hospital network. RESULTS: The authors of this paper have proven that it is possible to build a fast and reliable sharing system based on IHE profiles using most of the transactions of XDS-I with some adaptions to the clinical workflow. Primary hospital systems were enabled by building adapters to overcome lack of IHE compatibility. The established system embraces the existing security mechanisms in hospital networks while connecting patients and referring physicians from outside in a secure and convenient manner. CONCLUSIONS: A state-of-the-art sharing system that is used in a productive clinical environment has been established and is ready to grow with more partners. The system is the basis for an elaborated interdisciplinary collaboration where data, and in particular images, can now be shared between medical professionals.

O processo de trabalho no arquivo médico: novas perspectivas na produção do ato de cuidar em saúde / The medical archive work process: new perspectives concerning health care

Resumo Geralmente, estudos referidos ao arquivo médico se restringem à análise documental. Suas atividades alcançam pouca expressividade para além das teorias da administração científica, dificultando a percepção de que nestas possa ocorrer a produção do cuidado. O presente estudo propõe analisar o processo de trabalho dos trabalhadores do arquivo médico hospitalar a partir da dinâmica da micropolítica articulada à análise institucional. Enquanto pesquisa qualitativa descritiva, com referenciais da micropolítica do processo de trabalho em saúde e da Análise Institucional, o estudo identifica com analisadores questões do cotidiano do arquivo médico capazes de revelar estratégias elaboradas por seus trabalhadores e disputas que ocorrem no dia a dia. Assim, foi possível reconhecer em dois hospitais que estes trabalhadores detinham saberes importantes sobre a dinâmica do processo de trabalho em saúde. Como dinamizadores do processo de cuidado do usuário, estabelecem estratégias próprias na dinâmica de cuidar que incidem diretamente na dimensão cuidadora desses hospitais. Nesta perspectiva, introduzir novas investigações sobre este processo de trabalho possibilita diversificar o debate acerca do cuidado em saúde e ampliar o escopo de pesquisa referidas à saúde coletiva.

Abstract Generally, medical archive studies are restricted to the analysis of documents. Its activities achieve little expressiveness beyond the theories of scientific management, hampering the perception that care production may occur during these activities. This study aims to analyze hospital medical archive sector professionals' work process from the dynamics of micro-policy articulated with institutional analysis. As a descriptive qualitative research theoretically based on micro-policy of the health work process and Institutional Analysis, this study identifies with analyzers daily issues of the medical archive that can disclose strategies developed by health workers and disputes that occur on a daily basis. Therefore, it was possible to recognize in two hospitals that these workers held important knowledge about the dynamics of the health work process. As facilitators of user care process, they establish their own strategies in the dynamics of care that reflect directly on the care dimension of these hospitals. In this perspective, the introduction of new investigations about this work process allows us to diversify the debate about health care and broaden the scope of research referred to public health.

Clinical decision support systems at the Vienna General Hospital using Arden Syntax: Design, implementation, and integration.

INTRODUCTION: The Allgemeines Krankenhaus Informations Management (AKIM) project was started at the Vienna General Hospital (VGH) several years ago. This led to the introduction of a new hospital information system (HIS), and the installation of the expert system platform (EXP) for the integration of Arden-Syntax-based clinical decision support systems (CDSSs). In this report we take a look at the milestones achieved and the challenges faced in the creation and modification of CDSSs, and their integration into the HIS over the last three years. MATERIALS AND METHODS: We introduce a three-stage development method, which is followed in nearly all CDSS projects at the Medical University of Vienna and the VGH. Stage one comprises requirements engineering and system conception. Stage two focuses on the implementation and testing of the system. Finally, stage three describes the deployment and integration of the system in the VGH HIS. The HIS provides a clinical work environment for healthcare specialists using customizable graphical interfaces known as parametric medical documents. Multiple Arden Syntax servers are employed to host and execute the CDSS knowledge bases: two embedded in the EXP for production and development, and a further three in clinical routine for production, development, and quality assurance. RESULTS: Three systems are discussed; the systems serve different purposes in different clinical areas, but are all implemented with Arden Syntax. MONI-ICU is an automated surveillance system for monitoring healthcare-associated infections in the intensive care setting. TSM-CDS is a CDSS used for risk prediction in the formation of cutaneous melanoma metastases. Finally, TacroDS is a CDSS for the manipulation of dosages for tacrolimus, an immunosuppressive agent used after kidney transplantation. Problems in development and integration were related to data quality or availability, although organizational difficulties also caused delays in development and integration. DISCUSSION AND CONCLUSION: Since the inception of the AKIM project at the VGH and its ability to support standards such as Arden Syntax and integrate CDSSs into clinical routine, the clinicians' interest in, and demand for, decision support has increased substantially. The use of Arden Syntax as a standard for CDSSs played a substantial role in the ability to rapidly create high-quality CDSS systems, whereas the ability to integrate these systems into the HIS made CDSSs more popular among physicians. Despite these successes, challenges such as lack of (consistent and high-quality) electronic data, social acceptance among healthcare personnel, and legislative issues remain. These have to be addressed effectively before CDSSs can be more widely accepted and adopted.

Using Bioinformatics to Treat Hospitalized Smokers: Successes and Challenges of a Tobacco Treatment Service.

BACKGROUND: Hospitals face increasing regulations to provide and document inpatient tobacco treatment, yet few blueprint data exist to implement a tobacco treatment service (TTS). METHODS: A hospitalwide, opt-out TTS with three full-time certified counselors was developed in a large tertiary care hospital to proactively treat smokers according to Chronic Care Model principles and national treatment guidelines. A bioinformatics platform facilitated integration into the electronic health record to meet evolving Centers for Medicare & Medicaid Services meaningful use and Joint Commission standards. TTS counselors visited smokers at the bedside and offered counseling, recommended smoking cessation medication to be ordered by the primary clinical service, and arranged for postdischarge resources. RESULTS: During a 3.5-year span, 21,229 smokers (31,778 admissions) were identified; TTS specialists reached 37.4% (7,943), and 33.3% (5,888) of daily smokers received a smoking cessation medication order. Adjusted odds ratios (AORs) of receiving a chart order for smoking cessation medication during the hospital stay and at discharge were higher among patients the TTS counseled > 3 minutes and recommended medication: inpatient AOR = 7.15 (95% confidence interval [CI] = 6.59-7.75); discharge AOR = 5.3 (95% CI = 4.71-5.97). As implementation progressed, TTS counseling reach and medication orders increased. To assess smoking status ≤ 1 month postdischarge, three methods were piloted, all of which were limited by low follow-up rates (4.5%-28.6%). CONCLUSION: The TTS counseled approximately 3,000 patients annually, with increases over time for reach and implementation. Remaining challenges include the development of strategies to engage inpatient care teams to follow TTS recommendations, and patients postdischarge in order to optimize postdischarge smoking cessation.

Business performance management in university hospitals: a diagnosis in Brazilian institutions / Evaluación del desempeño empresarial en hospitales universitarios: un diagnóstico en las instituciones brasileñas

ABSTRACT Objectives To investigate whether business performance management practices are used by Brazilian federal university hospitals, and if so, to determine which practices are used and explore characteristics that may be related to their adoption. Method Descriptive ex post facto research on the effects of the studied variables in relation to the technical procedures. Secondary data and survey resources were used. Results Four hospitals use practices to assess business performance. Three of them stated that they use two different types of practices and that 75 % of university hospitals with at least one business performance management practice also have a strategic plan that includes vision, mission, objectives and long-term operational plans. Among the hospitals that do not use business performance management practices, 55.6 % claim to have strategic planning composed at least of mission, vision and long-term objectives. However, they stated that the entity has no plans to adopt any method. Conclusions This diagnosis intends to draw the attention of managers and other actors in the field of public health on the possibilities offered by performance evaluation systems to promote administrative improvements in a complex internal scenario with a need for rationalization of hospital costs in order to direct these institutions towards achieving their social mission.(AU)

RESUMEN Objetivo Investigar si la evaluación del desempeño empresarial es una práctica utilizada por los hospitales federales brasileños, y en caso que haya instituciones que utilicen esta herramienta, verificar cuales prácticas son utilizadas e investigar las posibles características que permiten adoptar las mismas. Método El estudio utilizó la investigación descriptiva, siendo ex post facto en cuanto a los efectos en las variables estudiadas, y con relación a los procedimientos técnicos, se utilizaron datos secundarios y recursos de encuesta. Resultados Los resultados muestran que cuatro hospitales utilizan prácticas sobre la evaluación del desempeño empresarial; tres de ellos declararon que utilizan dos tipos de prácticas diferentes y que el 75 % de los hospitales universitarios que tienen al menos una práctica de evaluación del desempeño empresarial, también tienen un plan estratégico con visión, misión e objetivos y planes operativos a largo plazo. Entre los hospitales que no tienen prácticas sobre la evaluación del desempeño empresarial, el 55,6 % afirman tener una planificación estratégica compuesta al menos de misión, visión y objetivos a largo plazo. Sin embargo, declararon que la entidad no tiene planes de adoptar ningún método elencado. Conclusiones Este diagnóstico pretende llamar la atención a la gerencia y a los funcionarios del campo de la salud pública, sobre las posibilidades que ofrecen los sistemas de evaluación del desempeño de las entidades, para promover mejoras administrativas en un escenario interno complejo, así como la continua necesidad de racionalización de los costos hospitalarios, de forma tal que conduzca estas instituciones a alcanzar su misión social.(AU)

The assessment of the complexity of care through the clinical nursing information system in clinical practice: a study protocol.

BACKGROUND: The costs of nursing staff amounts to approximately 50% of the total budget of the health workforce and accounts for 20% to 30% of the total costs incurred by the health care companies. The goal of the study, by analyzing the complexity of care, is to provide a quantification of the assistance delivered, through the assessment of the technical aspects of the welfare activities according to the variable of time. Data from these activities flow into the clinical nursing information system Professional Assessment Instrument - PAI - which is used at the health facility involved in this study. This instrument allows nurses to document the nursing process in electronic format by using a standardized nursing language (nursing diagnoses, nursing interventions and nursing outcomes). METHODS: The design of the study is observational. The participants will be patients that are hospitalized in the cardiology departments, the intensive care units for cardiac and thoracic surgery, pulmonary medicine and medical oncology of the "A.Gemelli" hospital in Rome, Italy. The observers who will carry out the surveys will be students of the nursing degree course and the coordinators of the respective wards. The times recorded for each health care activity will be correlated with variables that are defined in the literature as the indicators of the complexity of care. The research protocol was approved by the Ethics Committee of the "A. Gemelli" Hospital in June 2015. RESULTS: In terms of results, this study aims to verify the reliability of the Professional Assessment Instrument tool as a system for the classification and measurement of nursing care which includes the entire care process, taking into account all of the variables deemed crucial to the nursing care effort. CONCLUSIONS: This study will provide a tool for the assessment of the complexity of care, with the goal of improving the quality of care for the patients and of interacting with the health administration system for the management of resources.

[Software-based visualization of patient flow at a university eye clinic]. / Elektronische Visualisierung des ambulanten Patientenflows in einer Universitäts-Augenklinik.

OBJECTIVE: This article presents a method for visualization and navigation of patient flow in outpatient eye clinics with a high level of complexity. MATERIAL AND METHODS: A network-based software solution was developed targeting long-term process optimization by structural analysis and temporal coordination of process navigation. RESULTS: Each examination unit receives a separate waiting list of patients in which the patient flow for every patient is recorded in a timeline. Time periods and points in time can be executed by mouse clicks and the desired diagnostic procedure can be entered. Recent progress in any of these diagnostic requests, as well as a variety of information on patient progress are collated and drawn into the corresponding timeline which can be viewed by any of the personnel involved. The software called TimeElement has been successfully tested in the practical implemenation for several months. As an example the patient flow regarding time stamps of defined events for intravitreous injections on 250 patients was recorded and an average attendance time of 169.71 min was found, whereby the time was also automatically recorded for each individual stage. CONCLUSION: Recording of patient flow data is a fundamental component of patient flow management, waiting time reduction, patient flow navigation with time and coordination in particular regarding timeline-based visualization for each individual patient. Long-term changes in process management can be planned and evaluated by comparing patient flow data. As using the software itself causes structural changes within the organization, a questionnaire is being planned for appraisal by the personnel involved.

Accessing Patient Information for Probabilistic Patient Models Using Existing Standards.

Clinical decision support systems (CDSS) are developed to facilitate physicians' decision making, particularly for complex, oncological diseases. Access to relevant patient specific information from electronic health records (EHR) is limited to the structure and transmission formats in the respective hospital information system. We propose a system-architecture for a standardized access to patient specific information for a CDSS for laryngeal cancer. Following the idea of a CDSS using Bayesian Networks, we developed an architecture concept applying clinical standards. We recommend the application of Arden Syntax for the definition and processing of needed medical knowledge and clinical information, as well as the use of HL7 FHIR to identify the relevant data elements in an EHR to increase the interoperability the CDSS.

A Multi-Constraint Scheme with Authorized Mechanism for the Patient Safety.

Many research works have attempted to introduce passive RFID technology into medical systems to reduce medical errors. However, most of these proposed works focused on identifying patients and objects. If an RFID based medical system is only good for identifying patients and medical objects but not capable of halting any medical process immediately, then it is not possible to prevent medical errors from happening. Our research focuses on a mechanism to detect and to avoid medical harm before it occurs to patients. In this paper, we propose to incorporate multiple-constraints into the authorization scheme and used this scheme as a basis for implementing a medical management system avoiding medical errors to assist medical staff. Specifically, our scheme ensures that a medical operation is if and only if enabled when the constraints are being satisfied that an "identified patient" is being treated by a "certified medical staff member" within an "authorized area". In practical environments, our authorization scheme can be applied to various healthcare applications, and we develop a prototype system and test it in three applications: X-ray control, specimen collection, and blood transfusion management. The experimental results show that the system can be used to enable X-ray when the X-ray is in authorized location and operated by authorized operator. For the specimen collection and blood transfusion, the logs showing which medical staff has done specimen or blood transfusion on which patient at authorized location are correctly recorded into Hospital Information System (HIS). The locating process can be performed within 10 to 20 seconds, and the locating error is less than 2 meters.

Adverse events and near misses relating to information management in a hospital.

OBJECTIVE: This study described information management incidents and adverse event reporting choices of health professionals. METHODS: Hospital adverse events reported in an anonymous electronic reporting system were analysed using directed content analysis and descriptive and inferential statistics. The data consisted of near miss and adverse event incident reports (n = 3075) that occurred between January 2008 and the end of December 2009. RESULTS: A total of 824 incidents were identified. The most common information management incident was failure in written information transfer and communication, when patient data were copied or documented incorrectly. Often patient data were transferred using paper even though an electronic patient record was in use. Reporting choices differed significantly among professional groups; in particular, registered nurses reported more events than other health professionals. CONCLUSION: A broad spectrum of information management incidents was identified, which indicates that preventing adverse events requires the development of safe practices, especially in documentation and information transfer.

Scale-up of networked HIV treatment in Nigeria: creation of an integrated electronic medical records system.

OBJECTIVES: The implementation of PEPFAR programs in resource-limited settings was accompanied by the need to document patient care on a scale unprecedented in environments where paper-based records were the norm. We describe the development of an electronic medical records system (EMRS) put in place at the beginning of a large HIV/AIDS care and treatment program in Nigeria. METHODS: Databases were created to record laboratory results, medications prescribed and dispensed, and clinical assessments, using a relational database program. A collection of stand-alone files recorded different elements of patient care, linked together by utilities that aggregated data on national standard indicators and assessed patient care for quality improvement, tracked patients requiring follow-up, generated counts of ART regimens dispensed, and provided 'snapshots' of a patient's response to treatment. A secure server was used to store patient files for backup and transfer. RESULTS: By February 2012, when the program transitioned to local in-country management by APIN, the EMRS was used in 33 hospitals across the country, with 4,947,433 adult, pediatric and PMTCT records that had been created and continued to be available for use in patient care. Ongoing trainings for data managers, along with an iterative process of implementing changes to the databases and forms based on user feedback, were needed. As the program scaled up and the volume of laboratory tests increased, results were produced in a digital format, wherever possible, that could be automatically transferred to the EMRS. Many larger clinics began to link some or all of the databases to local area networks, making them available to a larger group of staff members, or providing the ability to enter information simultaneously where needed. CONCLUSIONS: The EMRS improved patient care, enabled efficient reporting to the Government of Nigeria and to U.S. funding agencies, and allowed program managers and staff to conduct quality control audits.

[Use of hospital data for ophthalmological research : A feasibility study]. / Nutzung von Krankenhausdaten zur ophthalmologischen Forschung : Eine Machbarkeitsstudie.

AIMS: This study was carried out to investigate whether ophthalmology hospitals can exchange patient data for research purposes, i.e. whether this is technically and legally feasible and whether it is worthwhile, i.e. whether the data are useful for answering important medical questions. METHODS: In-depth interviews were conducted with experts and a literature search was carried out. RESULTS: Patient data were found to be fundamentally well-suited for research purposes and there is a corresponding need for research. There are also specific scientific question which need to be answered, e.g. development of visual acuity after various surgical procedures for glaucoma. There are also legal and technical difficulties but it is possible to solve these problems. Potential solutions are described. DISCUSSION: The results of this study show that it is basically feasible for hospitals and hospital personnel to exchange patient data and to combine them. As opposed to earlier attempts which tried to collect as much data as possible and then analyzed what to do with the data afterwards, it is recommended that a medical question should first be defined followed by a search for data afterwards. Furthermore, researching would be facilitated by an improved exchange of data by information systems.

Developing a CIN for strategic value.

Clinically integrated networks (CINs) allow health systems and independent physicians to join in a mutually beneficial effort to adapt to new payment models. Key issues during planning for a CIN include organizational structure and governance, payer contracts, and incentive funds distribution. In assessing the network's potential financial impact, CIN planners should think in terms of managing total cost of care rather than in terms of revenues for care delivered.

Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool.

OBJECTIVE: To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period. DESIGN: Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation. SETTING: University-based, tertiary-care hospital. PARTICIPANTS: Internal medicine resident physicians admitting patients from the emergency department. INTERVENTION: An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers. MAIN OUTCOME MEASURES: (i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events. RESULTS: Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality. CONCLUSIONS: The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.