Skip to main content

Advertisement

SpringerLink
Log in

Supplementing Cross-Cover Communication with the Patient Acuity Rating

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

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.

OBJECTIVE

To determine PAR contribution to sign-outs.

DESIGN

Cross-sectional survey.

SUBJECTS

Intern physicians at a university teaching hospital.

INTERVENTIONS

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.

MAIN MEASURE

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.

KEY RESULTS

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).

CONCLUSIONS

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1.
Figure 2.
Figure 3.

Similar content being viewed by others

REFERENCES

  1. Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121(11):866–72.

    PubMed  CAS  Google Scholar 

  2. Vidyarthi AR. Fumbled handoff. AHRQ Web M & M. March 2004. Available at: http://webmm.ahrq.gov/case.aspx?caseID=55. Accessed: October 4, 2012.

  3. Singh H, Thomas EJ, Petersen LA, Studdert DM. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007;167(19):2030–6.

    Article  PubMed  Google Scholar 

  4. Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2):186–94.

    Article  PubMed  Google Scholar 

  5. Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14(6):401–7.

    Article  PubMed  CAS  Google Scholar 

  6. Borowitz SM, Waggoner-Fountain LA, Bass EJ, Sledd RM. Adequacy of information transferred at resident sign-out (in-hospital handover of care): a prospective survey. Qual Saf Health Care. 2008;17(1):6–10.

    Article  PubMed  CAS  Google Scholar 

  7. Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 2006;166(11):1173–7.

    Article  PubMed  Google Scholar 

  8. Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med. 2005;80(12):1094–9.

    Article  PubMed  Google Scholar 

  9. Vidyarthi AR, Arora V, Schnipper JL, Wall SD, Wachter RM. Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out. J Hosp Med. 2006;1(4):257–66.

    Article  PubMed  Google Scholar 

  10. Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755–60.

    Article  PubMed  Google Scholar 

  11. Chang VY, Arora VM, Lev-Ari S, D’Arcy M, Keysar B. Interns overestimate the effectiveness of their hand-off communication. Pediatrics. 2010;125(3):491–6.

    Article  PubMed  Google Scholar 

  12. Horwitz LI, Moin T, Green ML. Development and implementation of an oral sign-out skills curriculum. J Gen Intern Med. 2007;22(10):1470–4.

    Article  PubMed  Google Scholar 

  13. Accreditation Council for Graduate Medical Education (ACGME). Task Force on Quality Care and Professionalism. Proposed Standards: Common Program Requirements. 2010. Available at: http://www.acgme-2010standards.org/pdf/Common_Program_Requirements_07012011.pdf. Accessed: October 4, 2012.

  14. Byrne A. Mental workload as a key factor in clinical decision making. Adv Health Sci Educ Theory Pract. 2012. doi:10.1007/s10459-012-9360-5.

  15. Hodgetts TJ, Kenward G, Vlachonikolis IG, Payne S, Castle N. The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation. 2012;54(2):125–31.

    Article  Google Scholar 

  16. Edelson DP, Retzer E, Weidman EK, Woodruff J, Davis AM, Minsky BD, et al. Patient acuity rating: quantifying clinical judgment regarding inpatient stability. J Hosp Med. 2011;6(8):475–9.

    Article  PubMed  Google Scholar 

  17. Hirschtick RE. A piece of my mind. Copy-and-paste. JAMA. 2006;295(20):2335–6.

    Article  PubMed  CAS  Google Scholar 

  18. Wohlauer MV, Arora VM, Horwitz LI, Bass EJ, Mahar SE, Philibert I. The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care. Acad Med. 2012;87(4):411–8.

    Article  PubMed  Google Scholar 

  19. Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ. 2007;41(12):1140–5.

    PubMed  Google Scholar 

  20. Bachmann LM, Muhleisen A, Bock A, ter Riet G, Held U, Kessels AG. Vignette studies of medical choice and judgment to study caregivers’ medical decision behaviour: systematic review. BMC Med Res Methodol. 2008;8:50.

    Article  PubMed  Google Scholar 

  21. Cooksey RW. Judgment Analysis: theory, Methods, and Applications. San Diego: Academic; 1996.

    Google Scholar 

Download references

Acknowledgments

Contributors

We would like to thank Elizabeth Weidman and Jefferson Cua for their help in data collection and entry, Seo Young Park, PhD for statistical support, and Cara V. Phillips for graphics support.

Funders

This study was supported by the National Heart, Lung, and Blood Institute (K23 HL097157-01; PI: Edelson) and by a National Institute of Aging (5 T35 AG029795-02) grant for the Pritzker Summer Research Program.

Registry Number

clinicaltrials.gov NCT01082991

Prior Presentations

Prior poster presentation at the 2009 Society of Hospital Medicine Annual Meeting in Chicago, IL.

Conflict of Interest

Dr. Arora has received research support from Picker Institute (Grant #86) and National Institute of Aging (K23 AG033763), and is the on editorial board of Agency for Healthcare Research and Quality Web M&M. Dr. Edelson has received research support from the National Heart, Lung, and Blood Institute (K23 HL097157-01; PI: Edelson). Dr. Philips, Mr. Yuen, Dr. Retzer, and Dr. Woodruff declare they have no conflict of interests

Author information

Authors and Affiliations

  1. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Andrew W. Phillips MD, MEd & Vineet Arora MD, MA

  2. Department of Medicine, University of Chicago, Chicago, IL, USA

    Trevor C. Yuen BA, Elizabeth Retzer MD, James Woodruff MD, Vineet Arora MD, MA & Dana P. Edelson MD, MS

  3. Section of Hospital Medicine, University of Chicago Hospitals, 5841 S. Maryland Avenue, MC5000, Chicago, IL, 60637, USA

    Dana P. Edelson MD, MS

Authors
  1. Andrew W. Phillips MD, MEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trevor C. Yuen BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Retzer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Woodruff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vineet Arora MD, MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dana P. Edelson MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dana P. Edelson MD, MS.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

ESM 1

(PDF 68 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Phillips, A.W., Yuen, T.C., Retzer, E. et al. Supplementing Cross-Cover Communication with the Patient Acuity Rating. J GEN INTERN MED 28, 406–411 (2013). https://doi.org/10.1007/s11606-012-2257-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-012-2257-4

KEY WORDS

Search

Navigation