Understanding Physician Signout Risk Perception

Study Overview
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Brief Summary
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The purpose of the study is to compare the ability of physicians and a statistical index (the Rothman score) to predict clinical deterioration over the next 24 hours. Clinical deterioration is defined as concern in change in vital signs or patient status requiring a call to the rapid response team, cardiopulmonary arrest, or transfer to the ICU.

Detailed Description
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The proposed study will ask interns, residents, and attending physicians from general internal medicine teaching teams in a large teaching hospital to make predictions about the probability of their patient having a clinical deterioration in the next 24 hours. The investigators will compare these judgments to the Rothman index.

Official Title
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Understanding Physician Signout Risk Perception

Conditions
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Physician Judgment

Intervention / Treatment
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* Other: Clinical deterioration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Interns, residents, attendings in the Department of Medicine, Division of General Internal Medicine, University of Pittsburgh. Rotating on the general medical service at the University of Pittsburgh Medical Center - Presbyterian Hospital. Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Intern<br>Interns are in their first year of residency. | Other: Clinical deterioration<br>* Patients at risk of clinical deterioration<br>|
| Residents<br>Residents are in their 2nd or 3rd year of residency. | Other: Clinical deterioration<br>* Patients at risk of clinical deterioration<br>|
| Attendings<br>Attendings are physicians who have completed their residency. | Other: Clinical deterioration<br>* Patients at risk of clinical deterioration<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference between physician prediction of risk of clinical deterioration and Rothman Index | Physicians will make judgments about the probability of clinical deterioration for each of their patients on a 0 (definitely won't) to 100 (certainly will) scale. Clinical deterioration is defined as rapid response, cardiopulmonary arrest, or ICU transfer in the next 24 hours. The Rothman Index is an index that predicts clinical deterioration. The area under the receiver operating curve (AUROC) will be calculated for physicians and the Rothman Index. The AUROC measures the association between the physician's judgment or Rothman Index and actual clinical deterioration. The AUROC of these two measures will then be statistically compared. | Six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Judgment, risk assessment, clinical deterioration, cardiac arrest, Rothman Index