Department of Medicine, University of Chicago, Illinois, USA.
J Hosp Med. 2011 Oct;6(8):475-9. doi: 10.1002/jhm.886. Epub 2011 Aug 18.
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.
To develop and test a judgment-based scale for conveying the risk of clinical deterioration.
Prospective observational study.
University teaching hospital.
Internal medicine clinicians and patients.
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.
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.
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.
新的住院医师工作时间限制预计将导致住院患者之间的交接次数进一步增加，而交接是导致不良结果的已知风险因素。因此，需要制定和测试提高医务人员交班准确性和效率的策略。
开发并测试一种用于传递临床恶化风险的基于判断的量表。
前瞻性观察性研究。
大学教学医院。
内科临床医生和患者。
在交班时，由医生和中级执业医师获取患者病情严重程度评分（PAR），这是一个 7 分制的李克特评分，代表患者在接下来 24 小时内发生心脏骤停或转入重症监护病房（ICU）的可能性。交叉覆盖医生对结果不知情，随后将结果与结果相关联。
40 名符合条件的临床医生同意参与研究，对 3419 名患者的 6034 个独立评分进行了评估。74 个患者在 24 小时内发生心脏骤停或 ICU 转移。平均 PAR 为 3 ± 1，受试者工作特征曲线（AUROC）下面积为 0.82。特定于提供者的 AUROC 值范围为 0.69（住院医师）至 0.85（主治医生）（P = 0.01）。实习生和中级执业医师与其他组之间没有显著差异。PAR 为 4 或更高时，预测 24 小时内发生心脏骤停或 ICU 转移的敏感度为 82%，特异度为 68%。
可以通过简单的评分可靠地量化临床医生对患者稳定性的判断，并且在医疗保健人员之间进行交接时，有可能有效地传达对高风险患者的复杂评估。
