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
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Article info
Publication history
Published online: February 25, 2020
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