[Short-term prognostication of recently admitted patients to internal medicine wards by the staff].

BACKGROUND

The "dying patient" law in Israel deals with end- of-life decisions.

AIM

This prospective study evaluates the ability of internal medicine staff to assess the short-term prognosis of recently admitted patients.

METHODS

During the period November 1st 2008 until January 6th 2009, the staff of the internal medicine wards received questionnaires regarding their recently admitted patients (up to 72 hours from the time of admission). The questionnaires included thestaff member's role assessment of each patient's prognosis for the next two weeks. Later, charts of the patients were examined for demographic data and outcome.

RESULTS

Questionnaires regarding 599 patients were completed. The outcome was validated in 466 of these patients. Nurse's filled in 259 questionnaires, residents at early stage (before the first residency exam) completed 437, senior residents (after this exam] filled in 75 and senior/attending physicians filled in 329 patients' questionnaires. Overall, 69, patients died within 14 days. The sensitivity of assessment of short-term prognosis was low (0.38) but the specificity was very high (0.95). The positive predictive value was 0.61. Among physicians, the positive predictive value increased with seniority, but nurses had the highest positive predictive value scores (0.73). The negative predictive value was 0.89 without significant differences among the 4 studied groups.

CONCLUSIONS

Internal medicine staff has limited capacity to accurately assess short-term prognosis of recently admitted patients.