Recent research confirms what nurses and those who work with them have known for years: a nurse’s “worry factor” is an accurate predictor of a patient’s declining condition — and can save lives as a result.
Published in JAMIA Open, the Mayo Clinic study may pave the way for subjective measurements to be incorporated into electronic health records.
What Did the Study Find?
Using a five-point rating system, 150 nursing professionals at the Mayo Clinic in Rochester, Minnesota, were asked to predict each of their patient’s potential for decline within the next 24 hours. A total of 31,159 patient shifts, and 3,185 unique patients, were involved in the study.
To confirm accuracy, each report was then reviewed by three separate groups, a physician in the same specialty, an experienced nurse and either a physician, nurse or nurse practitioner. None of the reviewers, who were asked to determine whether they felt a bedside assessment was necessary, had personal contact with the patient.
Of the 492 cases in which the nurses rated a high level of worry, enough to call for medical attention, 77 percent were backed up by the reviewers. Nurses with more than one year of experience were significantly more accurate — 79 percent, as opposed to 68 percent for those with less than one year on the job.
Why Does the Study Matter?
Clearly, methods of predicting and therefore avoiding a patient’s decline are vital. Yet sometimes, objective measures — for example, automated scores based on neurological, skin or nutritional status collected from EMRs — don’t tell the full story. Applying a nurse’s trained eye to identify deteriorating patients can sometimes raise red flags even before objective markers can.
“Based on analytical or pattern recognition processes, our study demonstrates that the ‘worry factor’ in its current form is accurate in detecting patient deterioration,” wrote the study authors. “Nurses generally have more constant and prolonged contact with patients during their hospitalization as compared to physicians, putting them in a particularly advantaged position to recognize patterns that can be a telltale sign of impending physiological deterioration.”
What Does the Study Mean for Healthcare Professionals?
The study may have lasting effects on nurses’ roles in a hospital setting, granting nurses a bigger part in subjectively predicting and analyzing a patient’s status. The results prove that a combination of subjective and objective matters is the best indicator of a patient’s health.
“Our study is, to our knowledge, the first to measure the accuracy of nurses’ judgement (which in theory includes both pattern recognition skills and analytical assessment) to detect or predict acute inpatient deterioration with the use of a single score,” the JAMIA Open paper explained. “This simple score could be used alone, or easily incorporated into the existing Electronic Medical Record to potentially improve their performance.”