title: Patient acuity rating: quantifying clinical judgment regarding inpatient stability.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To develop and test a judgment-based scale for conveying the risk of clinical deterioration.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Internal medicine clinicians and patients.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Chicago, Illinois, USA. dperes@medicine.bsd.uchicago.edu
authors.forename: Dana P
authors.initials: DP
authors.lastname: Edelson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Retzer
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Weidman
authors.forename: James
authors.initials: J
authors.lastname: Woodruff
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davis
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.forename: William
authors.initials: W
authors.lastname: Meadow
authors.forename: Terry L Vanden
authors.initials: TL
authors.lastname: Hoek
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients / Q000145:classification*; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment