title: Interobserver reliability of attending physicians and bedside nurses when using an inpatient paediatric respiratory score.
abstract: OBJECTIVE
  This study aimed to determine the interobserver reliability between bedside nurses and attending physicians for a paediatric respiratory score as part of an asthma Integrated Care Pathway implementation.
  
  
  BACKGROUND
  An Integrated Care Pathway is one approach to improving quality of care for children hospitalised with asthma. Prior to implementation of the integrated care pathway, it was necessary to train nursing staff on the use of a respiratory assessment tool and to evaluate the interobserver reliability use of this tool.
  
  
  METHODS
  Prospective study using a convenience sample of children hospitalised for a respiratory illness in an academic medical centre.
  
  
  METHODS
  The respiratory assessment used was the Paediatric Asthma Score. Bedside nurse-attending physician (27 different RNs and three attending paediatric hospitalists) pairs performed 71 simultaneous patient assessments on 20 patients. Intraclass correlation coefficient and kappa statistics were used to assess interobserver reliability.
  
  
  RESULTS
  The overall intraclass correlation coefficient was nearly perfect where κ = 0·95, 95% CI (0·92, 0·97) and overall kappa for reliability based on clinically relevant score breakpoints was also high with κ = 0·82, 95% CI (0·75, 0·90). The majority of subgroup analyses revealed substantial to almost perfect agreement across a variety of diagnoses, age ranges, and individual score components.
  
  
  CONCLUSIONS
  Bedside nurses, with support and training from attending physicians, can perform respiratory assessments that agree almost perfectly with those of attending physicians.
  
  
  CONCLUSIONS
  The use of an Integrated Care Pathway allows for optimal interprofessional collaboration between bedside nurses and attending physicians.
authors.affiliation: Department of Pediatrics, Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Biondi
authors.forename: Julie Albright
authors.initials: JA
authors.lastname: Gottfried
authors.forename: Irene
authors.initials: I
authors.lastname: Dutko Fioravanti
authors.forename: Jan A
authors.initials: JA
authors.lastname: Schriefer
authors.forename: Claude Andrew
authors.initials: CA
authors.lastname: Aligne
authors.forename: Michael S
authors.initials: MS
authors.lastname: Leonard
mesh_terms: D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010808:Physical Examination; D011446:Prospective Studies; D015203:Reproducibility of Results; D012120:Respiration Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012129:Respiratory Function Tests
keywords: asthma; paediatric; reliability; score