Incorporating Patient Acuity Rating Score Into Patient Handoffs and the Correlation With Rapid Responses and Unexpected ICU Transfers

O’Donnell, Christopher; Thomas, Samantha; Johnson, Crystal L.; Verma, Lalit; Bae, Jonathan; Gallagher, David

doi:10.1177/1062860616630809

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Several early warning systems have been studied, including the Patient Acuity Rating, Modified Early Warning System, and others. [12][13][14][15][16] The advantage to using the I-PASS illness severity is the increasing adoption of this method for handoffs, so additional training and information at the time of handoff is not needed.…”

Section: Discussionmentioning

confidence: 99%

I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration

Shah

Sanber

Jacobson

et al. 2020

Journal of Graduate Medical Education

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Background The I-PASS framework is increasingly being adopted for patient handoffs after a recent study reported a decrease in medical errors and preventable adverse events. A key component of the I-PASS handoff included assignment of illness severity. Objective We evaluated whether illness severity categories can identify patients at higher risk of overnight clinical deterioration as defined by activation of the rapid response team (RRT). Methods The I-PASS handoff documentation created by internal medicine residents and patient charts with overnight RRT activations from April 2016 through March 2017 were reviewed retrospectively. The RRT activations, illness severity categories, vital signs prior to resident handoff, and patient outcomes were evaluated. Results Of the 28 235 written patient handoffs reviewed, 1.3% were categorized as star (sickest patients at risk for higher level of care), 18.8% as watcher (unsure of illness trajectory), and 79.9% as stable (improving clinical status). Of the 98 RRT activations meeting the inclusion criteria, 5.1% were labeled as star, 35.7% as watcher, and 59.2% as stable. Patients listed as watcher had an odds ratio of 2.6 (95% confidence interval 1.7–3.9), and patients listed as star had an odds ratio of 5.2 (95% confidence interval 2.1–13.1) of an overnight RRT activation compared with patients listed as stable. The overall in-hospital mortality of patients with an overnight RRT was 29.6%. Conclusions The illness severity component of the I-PASS handoff can identify patients at higher risk of overnight clinical deterioration and has the potential to help the overnight residents prioritize patient care.

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Section: Discussionmentioning

confidence: 99%

I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration

Shah

Sanber

Jacobson

et al. 2020

Journal of Graduate Medical Education

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“…3-6 However, direct comparisons to our sample of suspected ACS patients is difficult because these studies included both medical/surgical and transitional care units, and examined multiple diagnostic categories (i.e., respiratory, cardiac, endocrine, gastrointestinal, cancer, etc. ), and not specifically rule out ACS patients.…”

Section: Discussionmentioning

confidence: 99%

Unplanned transfer from the telemetry unit to the intensive care unit in hospitalized patients with suspected acute coronary syndrome

Pelter

Loranger

Kozik

et al. 2016

Journal of Electrocardiology

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Background Most patients presenting with suspected acute coronary syndrome (ACS) are admitted to telemetry units. While telemetry is an appropriate level of care, acute complications requiring a higher level of care in the intensive care unit (ICU) occur. Purpose Among patients admitted to telemetry for suspected ACS, we determine the frequency of unplanned ICU transfer, and examine whether ECG changes indicative of myocardial ischemia, and/or symptoms preceded unplanned transfer. Method This was a secondary analysis from a study assessing occurrence rates for transient myocardial ischemia (TMI) using a 12-lead Holter. Clinicians were blinded to Holter data as it was used in the context research; off-line analysis was performed post discharge. Hospital telemetry monitoring was maintained as per hospital protocol. TMI was defined as > 1 mm ST-segment ↑ or ↓, in > 1 ECG lead, > 1 minute. Symptoms were assessed by chart review. Results In 409 patients (64 + 13 years), most were men (60%), Caucasian (93%), and had a history of coronary artery disease (47%). Unplanned transfer to the ICU occurred in 9 (2.2%), was equivalent by gender, and age (no transfer 64 + 13 years vs transfer 67 +11 years). Four patients were transferred following unsuccessful percutaneous coronary intervention (PCI) attempt, four due to recurrent angina, and one due to renal and hepatic failure. Mean time from admission to transfer was 13 + 6 hours, mean time to ECG detected ischemia was 6 + 5 hours, and 8.8 + 5 hours for symptoms prompting transfer. In two patients ECG detected ischemia and acute symptoms prompting transfer were simultaneous. In five patients, ECG detected ischemia was clinically silent. All patients eventually had symptoms that prompted transfer to the ICU. In all nine patients, there was no documentation or nursing notes regarding bedside ECG monitor changes prior to unplanned transfer. Hospital length of stay was longer in the unplanned transfer group (2 days + 2 versus 6 days + 4; p = 0.018). Conclusions In patients with suspected ACS, while unplanned transfer from telemetry to ICU is uncommon, it is associated with prolonged hospitalization. Two primary scenarios were identified; (1) following unsuccessful PCI, and (2) recurrent angina. Symptoms prompting unplanned transfer occurred, but happened on average 8.8 hours after hospital admission; whereas ECG detected ischemia preceding unplanned transfer occurred on average 6 hours after hospital admission.

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“…Findings confirmed that significant predictive variables for patients at high risk for a re-admission to the ICU included temperature, platelets, arterial blood pressure, SPO2 and lactic acid. O'Donnell et al [23] evaluated the use of a physician acuity rating scale to assess the severity of illness, and to determine its impact on the number of rapid responses and intensive care unit transfers. The physician acuity rating scale was added to the sign-out sheet to support handoffs of patient admission to hospitalist services.…”

Section: Research Backgroundmentioning

confidence: 99%

Are Patient Admission Handoffs from the ED to MICU PARfect?

Ihianle

Burton

Abraham

2018

Proceedings of the International Symposium on Human Factors and

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Incorporating Patient Acuity Rating Score Into Patient Handoffs and the Correlation With Rapid Responses and Unexpected ICU Transfers

Cited by 5 publications

References 16 publications

I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration

I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration

Unplanned transfer from the telemetry unit to the intensive care unit in hospitalized patients with suspected acute coronary syndrome

Are Patient Admission Handoffs from the ED to MICU PARfect?

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