Journal of General Internal Medicine

, Volume 28, Issue 3, pp 406–411

Supplementing Cross-Cover Communication with the Patient Acuity Rating


  • Andrew W. Phillips
    • Pritzker School of MedicineUniversity of Chicago
  • Trevor C. Yuen
    • Department of MedicineUniversity of Chicago
  • Elizabeth Retzer
    • Department of MedicineUniversity of Chicago
  • James Woodruff
    • Department of MedicineUniversity of Chicago
  • Vineet Arora
    • Pritzker School of MedicineUniversity of Chicago
    • Department of MedicineUniversity of Chicago
    • Department of MedicineUniversity of Chicago
    • Section of Hospital MedicineUniversity of Chicago Hospitals
Original Research

DOI: 10.1007/s11606-012-2257-4

Cite this article as:
Phillips, A.W., Yuen, T.C., Retzer, E. et al. J GEN INTERN MED (2013) 28: 406. doi:10.1007/s11606-012-2257-4



Patient hand-offs at physician shift changes have limited ability to convey the primary team’s longitudinal insight. The Patient Acuity Rating (PAR) is a previously validated, 7-point scale that quantifies physician judgment of patient stability, where a higher score indicates a greater risk of clinical deterioration. Its impact on cross-covering physician understanding of patients is not known.


To determine PAR contribution to sign-outs.


Cross-sectional survey.


Intern physicians at a university teaching hospital.


Subjects were surveyed using randomly chosen, de-identified patient sign-outs, previously assigned PAR scores by their primary teams. For each sign-out, subjects assigned a PAR score, then responded to hypothetical cross-cover scenarios before and after being informed of the primary team’s PAR.


Changes in intern assessment of the scenario before and after being informed of the primary team’s PAR were measured. In addition, responses between novice and experienced interns were compared.


Between May and July 2008, 23 of 39 (59 %) experienced interns and 25 of 42 (60 %) novice interns responded to 480 patient scenarios from ten distinct sign-outs. The mean PAR score assigned by subjects was 4.2 ± 1.6 vs. 3.8 ± 1.8 by the primary teams (p < 0.001). After viewing the primary team’s PAR score, interns changed their level of concern in 47.9 % of cases, their assessment of the importance of immediate bedside evaluation in 48.7 % of cases, and confidence in their assessment in 43.2 % of cases. For all three assessments, novice interns changed their responses more frequently than experienced interns (p = 0.03, 0.009, and <0.001, respectively). Overall interns reported the PAR score to be theoretically helpful in 70.8 % of the cases, but this was more pronounced in novice interns (81.2 % vs 59.6 %, p < 0.001).


The PAR adds valuable information to sign-outs that could impact cross-cover decision-making and potentially benefit patients. However, correct training in its use may be required to avoid unintended consequences.


hospital medicinemedical education assessment methodscommunication

Supplementary material

11606_2012_2257_MOESM1_ESM.pdf (69 kb)
ESM 1(PDF 68 kb)

Copyright information

© Society of General Internal Medicine 2012