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Supplementing Cross-Cover Communication with the Patient Acuity Rating

Phillips, Andrew ; Yuen, Trevor ; Retzer, Elizabeth ; Woodruff, James ; Arora, Vineet ; Edelson, Dana

Journal of General Internal Medicine, 2013, Vol.28(3), pp.406-411 [Tạp chí có phản biện]

ISSN: 0884-8734 ; E-ISSN: 1525-1497 ; DOI: 10.1007/s11606-012-2257-4

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  • Nhan đề:
    Supplementing Cross-Cover Communication with the Patient Acuity Rating
  • Tác giả: Phillips, Andrew ; Yuen, Trevor ; Retzer, Elizabeth ; Woodruff, James ; Arora, Vineet ; Edelson, Dana
  • Chủ đề: hospital medicine ; medical education assessment methods ; communication
  • Là 1 phần của: Journal of General Internal Medicine, 2013, Vol.28(3), pp.406-411
  • Mô tả: 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.
  • Ngôn ngữ: English
  • Số nhận dạng: ISSN: 0884-8734 ; E-ISSN: 1525-1497 ; DOI: 10.1007/s11606-012-2257-4

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