We thank Bittner for his thoughtful comments about our article.1 Bittner wonders whether our results might vary by volume, patient population, day of the week, perceived experience, ability and personality of the participants, or other characteristics. We were unable to conduct any meaningful subgroup analyses owing to the relatively small number of adverse events in the study. It is notable, however, that many of the sign-out–related problems identified by residents were not related to acute illness but to routine matters for which information or understanding was insufficient. We thus suspect that sign-out–related problems such as these are endemic in every hospital setting. Further research would now be valuable to tease out the relative influence of volume, severity of illness, day of the week, individual experience, and other factors on sign-out quality.
Horwitz LI, Moin T, Krumholz HM, Bradley EH. Editor's Correspondence: COMMENTS AND OPINIONS. Arch Intern Med. 2009;169(8):809–813. doi:10.1001/archinternmed.2009.86
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