Inefficient, time-consuming, and frustrating experiences with the gastroenterology sign-off process inspired doctors at Northwestern Medicine, in Chicago, to design a standardized form for this purpose. To identify the most useful information to include, they consulted with primary care colleagues, ultimately developing a formal GI sign-off form they say highlights relevant information, boosts discharge efficiency, and saves time.
“By standardizing the sign-off process, we’ve … seen drastically improved primary team satisfaction, which we hope reflects [an] improved patient experience as well. It has also allowed for there to be less confusion when both our consulting team and primary teams transition providers,” said lead researcher Sukrit Jain, MD, a gastroenterology fellow at Northwestern Medicine. “As a side benefit, we’re anecdotally seeing fewer pages, which lightens the workload on a busy day.”
Increased Satisfaction
A survey assessing provider satisfaction with the GI sign-off process prior to and six months after the new protocol, as well as the most requested items to include on the form, was presented at DDW 2025 (abstract Su1090). At baseline, none of the primary care team members surveyed were “very satisfied” with the sign-off note, and 45% reported being “satisfied.” After the pilot period, 30% were very “satisfied” and 42% were “satisfied.” Those responding that they were “very unsatisfied” decreased from 10% to zero.
Historically, the general GI service at Northwestern most often paged primary care teams to share recommendations, due to the high volume of daily consults. This practice often resulted in back-and-forth pages, Dr. Jain said. “If we were delayed in responding due to significant patient volume, then that could lead to delays in patient care and primary care team frustrations,” he added.
To make the sign-off process more useful, Dr. Jain and his co-investigators surveyed the Northwestern primary care team on how they prefer to be notified when sign-off is complete, soliciting suggestions for improvement.
The survey revealed that 35% of providers preferred a note, 20% to be paged, and 45% preferred both a page and a note. The new sign-off note generally has replaced paging, Dr. Jain said.
GI-related medication changes and GI clinic follow-up details were the two most requested elements for the new sign-off note. Repeat endoscopy and pathology findings, if applicable, were highly requested as well. Dietary recommendations were added based on feedback from a follow-up survey.
“Implementing a standardized sign-off note using primary teams’ most requested details dramatically improved their satisfaction with the GI sign-off process,” the investigators noted. “Anecdotally, fellows did not find this burdensome and appreciated the note providing key details if GI was reconsulted.”
‘Low-Hanging Fruit’
“I do think this process… is appropriate, helpful, and care-centric. I may well steal the concept and institute something similar here,” said Neil Stollman, MD, the chief of the division of gastroenterology at Alta Bates Summit Medical Center, in Oakland, California.
“Historically, I’d like to think that I explicitly write all the important things in that note in my regular progress note when I sign off,” Dr. Stollman added. “But having it codified in one sheet is undoubtedly helpful, both in prompting the consultant to provide those key follow-up plans, as well as seeing them among all the noise of a note on the managing team’s end.”
Arun Swaminath, MD, the chief of gastroenterology at Lenox Hill Hospital of Northwell Health, in New York City, said “The Northwestern idea of the standardized sign-off note is fantastic, as it addresses the most important questions for the primary care team and minimizes the number of post-hospitalization appointments, especially if the patient doesn’t need a GI follow-up, in the post-acute care setting.”
Dr. Swaminath described the initiative as practical, saying that the form is in the category of “high-yield, low-hanging fruit,” adding, “We will be looking to incorporate some of these ideas as we transition into a new [electronic medical record] for our healthcare system.”
“We would highly recommend reaching out to … primary care teams to see what information they would find most helpful,” Dr. Jain said of other gastroenterologists who want to implement a similar protocol at their institution. “In general, though, from speaking to colleagues at other institutions, the common questions are most often about diet, medication resumption, and follow-up plan.”
—Damian McNamara
This article is from the December 2025 print issue.