Original Research

Patient acuity rating: Quantifying clinical judgment regarding inpatient stability

Abstract

Abstract

BACKGROUND:

New resident work‐hour restrictions are expected to result in further increases in the number of handoffs between inpatient care providers, a known risk factor for poor outcomes. Strategies for improving the accuracy and efficiency of provider sign‐outs are needed.

OBJECTIVE:

To develop and test a judgment‐based scale for conveying the risk of clinical deterioration.

DESIGN:

Prospective observational study.

SETTING:

University teaching hospital.

SUBJECTS:

Internal medicine clinicians and patients.

MEASUREMENTS:

The Patient Acuity Rating (PAR), a 7‐point Likert score representing the likelihood of a patient experiencing a cardiac arrest or intensive care unit (ICU) transfer within the next 24 hours, was obtained from physicians and midlevel practitioners at the time of sign‐out. Cross‐covering physicians were blinded to the results, which were subsequently correlated with outcomes.

RESULTS:

Forty eligible clinicians consented to participate, providing 6034 individual scores on 3419 patient‐days. Seventy‐four patient‐days resulted in cardiac arrest or ICU transfer within 24 hours. The average PAR was 3 ± 1 and yielded an area under the receiver operator characteristics curve (AUROC) of 0.82. Provider‐specific AUROC values ranged from 0.69 for residents to 0.85 for attendings (P = 0.01). Interns and midlevels did not differ significantly from the other groups. A PAR of 4 or higher corresponded to a sensitivity of 82% and a specificity of 68% for predicting cardiac arrest or ICU transfer in the next 24 hours.

CONCLUSIONS:

Clinical judgment regarding patient stability can be reliably quantified in a simple score with the potential for efficiently conveying complex assessments of at‐risk patients during handoffs between healthcare members. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine