Advertisement

Nurses’ judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores

Published:February 25, 2020DOI:https://doi.org/10.1016/j.hrtlng.2020.02.037

      Highlights

      • Agreement between nurses on patient risk of deterioration was fair to moderate.
      • Nurses agreed more between themselves than with early warning scores.
      • The correlation between nurses’ judgments and early warning scores was stronger on the surgical unit.
      • Nurses’ level of agreement did not differ depending on their first language, years of experience, or educational level.

      Abstract

      Background

      Nurses begin forming judgments regarding patients’ clinical stability during change-of-shift handoffs.

      Objectives

      To examine the agreement between incoming and outgoing nurses’ judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS).

      Methods

      Following handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale.

      Results

      Sixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings.

      Conclusion

      Nurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lavoie P.
        • Pepin J.
        • Alderson M.
        Defining patient deterioration through acute care and intensive care nurses' perspectives.
        Nurs Crit Care. 2016; 21: 68-77https://doi.org/10.1111/nicc.12114
        • Tanner C.A.
        Thinking like a nurse: a research-based model of clinical judgment in nursing.
        J Nurs Educ. 2006; 45: 204-211https://doi.org/10.3928/01484834-20060601-04
        • Cohen M.D.
        • Hilligoss P.B.
        The published literature on handoffs in hospitals: deficiencies identified in an extensive review.
        Qual Saf Health Care. 2010; 19: 493-497https://doi.org/10.1136/qshc.2009.033480
        • Staggers N.
        • Blaz J.W.
        Research on nursing handoffs for medical and surgical settings: an integrative review.
        J Adv Nurs. 2013; 69: 247-262https://doi.org/10.1111/j.1365-2648.2012.06087.x
        • Riesenberg L.A.
        • Leitzsch J.
        • Cunningham J.M.
        Nursing handoffs: a systematic review of the literature.
        Am J Nurs. 2010; 110: 24-34https://doi.org/10.1097/01.naj.0000370154.79857.09
        • Ericsson K.A.
        • Whyte J.
        • Ward P.
        Expert performance in nursing: reviewing research on expertise in nursing within the framework of the expert-performance approach.
        Adv Nurs Sci. 2007; 30: E58-E71https://doi.org/10.1097/00012272-200701000-00014
        • Hammond K.R.
        Human Judgment and Social Policy: Irreducible uncertainty, Inevitable error, Unavoidable Injustice.
        Oxford University Press, New York, NY1996
        • Stamp K.D.
        How nurse practitioners make decisions regarding coronary heat disease risk: a social judgment analysis.
        Int J Nurs Knowl. 2012; 23: 29-40https://doi.org/10.1111/j.2047-3095.2011.01196.x
        • Thompson C.
        • Bucknall T.
        • Estabrookes C.A.
        • Hutchinson A.
        • Fraser K.
        • de Vos R.
        • et al.
        Nurses' critical event risk assessments: a judgement analysis.
        J Clin Nurs. 2007; 18: 601-612https://doi.org/10.1111/j.1365-2702.2007.02191.x
        • Yang H.
        • Thompson C.
        Capturing judgement strategies in risk assessments with improved quality of clinical information: how nurses' strategies differ from the ecological model.
        BMC Med Inform Decis Mak. 2016; 16: 7https://doi.org/10.1186/s12911-016-0243-1
        • Buist M.D.
        • Jarmolowski E.
        • Burton P.R.
        • Bernard S.A.
        • Waxman B.P.
        • Anderson J.
        Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care: a pilot study in a tertiary-care hospital.
        Med J Aust. 1999; 171: 22-25https://doi.org/10.5694/j.1326-5377.1999.tb123492.x
        • Hodgetts T.J.
        • Kenward G.
        • Vlackonikolis I.
        • Payne S.
        • Castle N.
        • Crouch R.
        • et al.
        Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital.
        Resuscitation. 2002; 54: 115-123https://doi.org/10.1016/s0300-9572(02)00098-9
        • Churpek M.M.
        • Adhikari R.
        • Edelson D.P.
        The value of vital sign trends for detecting clinical deterioration on the wards.
        Resuscitation. 2016; 102: 1-5https://doi.org/10.1016/j.resuscitation.2016.02.005
        • Jeffery A.D.
        • Dietrich M.S.
        • Fabbri D.
        • Kennedy B.
        • Novak L.L.
        • Coco J.
        • et al.
        Advancing in-hospital clinical deterioration prediction models.
        Am J Crit Care. 2018; 27: 381-391https://doi.org/10.4037/ajcc2018957
        • Kipnis P.
        • Turk B.J.
        • Wulf D.A.
        • LaGuardia J.C.
        • Liu V.
        • Churpek M.M.
        • et al.
        Development and validation of an electronic medical record-based alert score for detection of inpatient deterioration outside the ICU.
        J Biomed Inform. 2016; 64: 10-19https://doi.org/10.1016/j.jbi.2016.09.013
        • Subbe C.
        • Kruger M.
        • Rutherford P.
        • Gemmel L.
        Validation of a modified early warning score in medical admissions.
        QJM. 2001; 94: 507-510https://doi.org/10.1093/qjmed/94.10.521
        • Royal College of Physicians
        National Early Warning Score (NEWS): Standardising the Assessement of Acute-Illness Severity in the NHS.
        London: Royal College of Physicians, 2012
        • Prytherch D.R.
        • Smith G.B.
        • Schmidt P.E.
        • Featherstone P.I.
        ViEWS—Towards a national early warning score for detecting adult inpatient deterioration.
        Resuscitation. 2010; 81: 932-937https://doi.org/10.1016/j.resuscitation.2010.04.014
        • Downey C.L.
        • Tahir W.
        • Randell R.
        • Brown J.M.
        • Jayne D.G.
        Strengths and limitations of early warning scores: a systematic review and narrative synthesis.
        Int J Nurs Stud. 2017; 76: 106-119https://doi.org/10.1016/j.ijnurstu.2017.09.003
        • Smith M.E.B.
        • Chiovaro J.C.
        • O'Neil M.
        • Kansagara D.
        • Quinones A.R.
        • Freeman M.
        • et al.
        Early warning system scores for clinical deterioration in hospitalized patients: a systematic review.
        Ann Am Thorac Soc. 2014; 11: 1454-1465https://doi.org/10.1513/annalsats.201403-102oc
        • Braaten J.S.
        Hospital system barriers to rapid response team activation: a cognitive work analysis.
        Am J Nurs. 2015; 2015: 22-33https://doi.org/10.1097/01.NAJ.0000460673.82070.af
        • Donohue L.A.
        • Endacott R.
        Track, trigger and teamwork: communication of deterioration in acute medical and surgical wards.
        Intensive Crit Care Nurs. 2010; 26: 10-17https://doi.org/10.1016/j.iccn.2009.10.006
        • Kitto S.
        • Marshall S.D.
        • McMillan S.E.
        • Shearer B.
        • Buist M.
        • Grant R.
        • et al.
        Rapid response systems and collective (in)competence: an exploratory analysis of intraprofessional and interprofessional activation factors.
        J Interprof Care. 2015; 29: 340-346https://doi.org/10.3109/13561820.2014.984021
        • Odell M.
        Detection and management of the deteriorating ward patient: an evaluation of nursing practice.
        J Clin Nurs. 2015; 24: 173-182https://doi.org/10.1111/jocn.12655
        • Douw G.
        • Schoonhoven L.
        • Holwerda T.
        • Huisman-de Waal G.
        • van Zanten A.R.
        • van Achterberg T.
        • et al.
        Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review.
        Crit Care. 2015; 19: 230https://doi.org/10.1186/s13054-015-0950-5
        • Hodgetts T.J.
        • Kenward G.
        • Vlachonikolis I.G.
        • Payne S.
        • Castle N.
        The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team.
        Resuscitation. 2002; 54: 125-131https://doi.org/10.1016/s0300-9572(02)00100-4
        • Jacques T.
        • Harrison G.A.
        • McLaws M.-.L.
        • Kilborn G.
        Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the inpatient setting.
        Resuscitation. 2006; 69: 175-183https://doi.org/10.1016/j.resuscitation.2005.08.015
        • Buist M.D.
        • Moore G.E.
        • Bernard S.A.
        • Waxman B.P.
        • Anderson J.N.
        • Nguyen T.V.
        Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study.
        Br Med J. 2002; 324: 1-6https://doi.org/10.1136/bmj.324.7334.387
        • Massey D.
        • Chaboyer W.
        • Anderson V.
        What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature.
        Nurs Open. 2017; https://doi.org/10.1002/nop2.53
        • Lavoie P.
        • Clarke S.P.
        • Clausen C.
        • Purden M.
        • Emed J.
        • Mailhot T.
        • et al.
        Acceptability and feasibility of recruitment and data collection in a field study of hospital nurses' handoffs using mobile devices.
        Pilot Feasibility Stud. 2018; 4: 163https://doi.org/10.1186/s40814-018-0353-x
        • Edelson D.P.
        • Retzer E.
        • Weidman E.K.
        • Woodruff J.
        • Davis A.M.
        • Minsky B.D.
        • et al.
        Patient acuity rating: quantifying clinical judgment regarding inpatient stability.
        J Hosp Med. 2011; 6: 480-488https://doi.org/10.1002/jhm.886
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101https://doi.org/10.1191/1478088706qp063oa
        • Ratelle J.T.
        • Kelm D.J.
        • Halvorsen A.J.
        • West C.P.
        • Oxentenko A.S.
        Predicting and communicating risk of clinical deterioration: an observational cohort study of internal medicine residents.
        J Gen Intern Med. 2015; 30: 448-453https://doi.org/10.1007/s11606-014-3114-4
        • Kovacs C.
        • Jarvis S.W.
        • Prytherch D.R.
        • Meredith P.
        • Schmidt P.E.
        • Briggs J.S.
        • et al.
        Comparison of the national early warning score in non-elective medical and surgical patients.
        Br J Surg. 2016; 103: 1385-1393https://doi.org/10.1002/bjs.10267
        • Spengler P.M.
        • White M.J.
        • Ægisdóttir S.
        • Maugherman A.S.
        • Anderson L.A.
        • Cook R.S.
        • et al.
        The meta-analysis of clinical judgment project effects of experience on judgment accuracy.
        Couns Psychol. 2009; 37: 350-399https://doi.org/10.1177/0011000006295149
        • Mussweiler T.
        Comparison processes in social judgment: mechanisms and consequences.
        Psychol. Rev. 2003; 110: 472-489https://doi.org/10.1037/0033-295x.110.3.472