title: Supplementing cross-cover communication with the patient acuity rating.
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.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Intern physicians at a university teaching hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Phillips
authors.forename: Trevor C
authors.initials: TC
authors.lastname: Yuen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Retzer
authors.forename: James
authors.initials: J
authors.lastname: Woodruff
authors.forename: Vineet
authors.initials: V
authors.lastname: Arora
authors.forename: Dana P
authors.initials: DP
authors.lastname: Edelson
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004521:Educational Measurement / Q000379:methods; D005260:Female; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007087:Illinois; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D062072:Patient Acuity; D062209:Patient Handoff / Q000458:organization & administration*