ASSOCIATION FOR ACADEMIC SURGERY The Computerized Rounding Report: Implementation of a Model System to Support Transitions of Care 1 Max V. Wohlauer, M.D.,* ,2 Kyle O. Rove, M.D.,* , † Thomas J. Pshak, M.D.,* , † Christopher D. Raeburn, M.D.,* Ernest E. Moore, M.D.,* , ‡ Chad Chenoweth, B.S.,§ Apoorva Srivastava, B.S.,§ Jonathan Pell, M.D.,k Randall B. Meacham, M.D.,* , † and Mark R. Nehler, M.D.* *Department of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado; †Department of Surgery, Division of Urology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado; ‡Department of Surgery, Denver Health Medical Center, Denver, Colorado; §Web Architect, eBusiness, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado; and kDepartment of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado Originally submitted January 11, 2011; accepted for publication April 6, 2011 Objectives. In response to ACGME work-hour re- strictions, residency programs that require continu- ous inpatient clinical care for educational objectives will be forced to increase the proportion of junior res- ident experience involved in shift work. Maintaining the balance of education over service at these levels will be a challenge, where a considerable amount of time must be spent gathering data for morning rounds and signing out patients at shift change. Patient safety is an issue with this new paradigm. We hypothesized that computerized sign-out would improve resident efficiency. Materials and Methods. A multidisciplinary clinical team collaborated to design a computerized rounding and sign-out (CSO) program to automate collection of clinical information in addition to a brief narrative de- scribing ongoing care issues. Residents returned a self- administered questionnaire before (n [ 168) and after implementation (n [ 83) examining: pre-rounding time, missed patients, handoff quality, and duty hours. Results. Residents reported spending 11 fewer min/ d pre-rounding (P [ 0.006). After implementation, res- idents missed fewer patients on rounds (P [ 0.01). A majority (70%) of responders stated that the new pro- gram helped them with duty hours. Conclusion. The current study demonstrates the re- producibility of the University of Washington model system for rounding and sign-out at an independent site, using basic infrastructure and leadership com- mon to all residency programs. Developing a CSO was associated with a modest reduction in pre- rounding time and fewer patients missed on rounds. Although automating resident tasks may improve workflow in an increasingly complex hospital environ- ment, structured handoff education and other institu- tional changes are necessary. Ó 2012 Elsevier Inc. All rights reserved. Key Words: continuity of patient care; surgery; edu- cation; internal medicine; handoff; handover; comput- erized sign-out; sign-out; signout; medical records systems; patient care; information technology; gradu- ate medical education; ACGME; UWCores; computer supported cooperative work; residency. INTRODUCTION In 1999, the Institute of Medicine (IOM) published the report To Err is Human that brought patient safety to the forefront of public attention [1]. The report con- cluded that medical injury was a serious and common problem, affecting approximately one in ten hospital- ized patients and causing hundreds of thousands of preventable deaths each year [2]. Two years later, in Crossing the Quality Chasm [3], the IOM stressed the role of information technology in improving the quality of health care [4]. The authors of this report asserted that ‘‘personal health information must accompany pa- tients as they transition from home to a clinical office setting to hospital to nursing home and back [.] this commitment should lead to the elimination of most handwritten clinical data by the end of the decade.’’ They also correctly predicted that ‘‘in the absence of 1 Presented at the 6th Academic Surgical Congress. Huntington Beach, CA, February 1, 2011. 2 To whom correspondence and reprint requests should be ad- dressed at Department of Surgery, University of Colorado Denver, An- schutz Medical Campus, 12700 E 19th Avenue, C320, Aurora, CO 80045. E-mail: Max.Wohlauer@ucdenver.edu. 0022-4804/$36.00 Ó 2012 Elsevier Inc. All rights reserved. 11 Journal of Surgical Research 172, 11–17 (2012) doi:10.1016/j.jss.2011.04.015