New tool developed to reduce risks to patients during clinical handoffs
Research Activities, August 2012, No. 384
New restrictions on medical resident duty hours in hospitals may raise the risk of poor patient outcomes by increasing the number of handoffs between inpatient care providers. During the handoff process, physicians routinely use written sign-outs to convey important information to covering physicians, with the result being loss of information and decreased communication. The least commonly conveyed information, according to one recent study, was the patient's current clinical condition. However, a new tool uses a simple score with potential to convey complex assessment of at-risk patients during clinical handoffs.
Researchers from the University of Chicago have developed a simple tool for quantifying provider judgment in order to predict which floor patients may suffer cardiac arrest or emergency intensive care unit (ICU) transfer in the next 24 hours. The tool, called the Patient Acuity Rating (PAR), is a 7-point Likert scale to quantify clinician judgment regarding the stability of inpatients outside of the ICU. Providers were prospectively surveyed once per call-cycle on the day after patient admission and asked to rate each of their patients on their likelihood of suffering a cardiac arrest or being transferred to the ICU.
PAR scores were obtained for 1,663 patients over the course of 2,019 admissions to a large academic medical center. The risk of clinical deterioration decreased as the PAR score got closer to 1 for all provider types (attending, resident, intern, and midlevel providers). Attending physician judgment was most predictive and resident judgment the least predictive of clinical deterioration.
The researchers concluded that the PAR has the potential to be added to any handoff system as a way to convey individual severity of illness for patients. It also has potential use in risk stratifying patients for interventions, such as increased vital sign monitoring. This research was supported in part by the Agency for Healthcare Research and Quality (HS16967).
See "Patient acuity rating: Quantifying clinical judgment regarding inpatient stability," by Dana P. Edelson, M.D., Elizabeth Retzer, M.D., Elizabeth K. Weidman, B.A., and others in the Journal of Hospital Medicine 6, pp. 475-479, 2011.