Interobserver reliability of attending physicians and bedside nurses when using an inpatient paediatric respiratory score
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Published on: April 8, 2022
Eric A Biondi1, Julie Albright Gottfried, Irene Dutko Fioravanti
1Department of Pediatrics, Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, USA.
Insights
Bedside nurses and physicians demonstrated high agreement when using a paediatric respiratory score. This collaboration, supported by an asthma Integrated Care Pathway, enhances care quality for hospitalised children.
Area of Science:
- Pediatric respiratory assessment
- Healthcare quality improvement
- Interprofessional collaboration
Background:
- Integrated Care Pathways (ICPs) improve care for hospitalized pediatric asthma patients.
- Training nursing staff on respiratory assessment tools is crucial before ICP implementation.
- Evaluating interobserver reliability of assessment tools is necessary for ICP success.
Purpose of the Study:
- To assess interobserver reliability of a pediatric respiratory score between bedside nurses and attending physicians.
- To support the implementation of an asthma Integrated Care Pathway.
- To evaluate the effectiveness of a standardized respiratory assessment tool.
Main Methods:
- Prospective study in an academic medical center.
- Paediatric Asthma Score used for respiratory assessment.
- 71 simultaneous assessments by nurse-physician pairs on 20 pediatric patients.
Main Results:
- Nearly perfect overall agreement (ICC = 0.95) between nurses and physicians.
- High reliability for clinically relevant score breakpoints (kappa = 0.82).
- Substantial to almost perfect agreement across various diagnoses and age groups.
Conclusions:
- Bedside nurses, with physician support and training, can reliably perform pediatric respiratory assessments.
- The Paediatric Asthma Score demonstrates excellent interobserver reliability.
- Integrated Care Pathways facilitate effective interprofessional collaboration in pediatric asthma care.
Aims And Objectives:
This study aimed to determine the interobserver reliability between bedside nurses and attending physicians for a paediatric respiratory score as part of an asthma Integrated Care Pathway implementation.
Background:
An Integrated Care Pathway is one approach to improving quality of care for children hospitalised with asthma. Prior to implementation of the integrated care pathway, it was necessary to train nursing staff on the use of a respiratory assessment tool and to evaluate the interobserver reliability use of this tool.
Design:
Prospective study using a convenience sample of children hospitalised for a respiratory illness in an academic medical centre.
Methods:
The respiratory assessment used was the Paediatric Asthma Score. Bedside nurse-attending physician (27 different RNs and three attending paediatric hospitalists) pairs performed 71 simultaneous patient assessments on 20 patients. Intraclass correlation coefficient and kappa statistics were used to assess interobserver reliability.
Results:
The overall intraclass correlation coefficient was nearly perfect where κ = 0·95, 95% CI (0·92, 0·97) and overall kappa for reliability based on clinically relevant score breakpoints was also high with κ = 0·82, 95% CI (0·75, 0·90). The majority of subgroup analyses revealed substantial to almost perfect agreement across a variety of diagnoses, age ranges, and individual score components.
Conclusions:
Bedside nurses, with support and training from attending physicians, can perform respiratory assessments that agree almost perfectly with those of attending physicians.
Relevance To Clinical Practice:
The use of an Integrated Care Pathway allows for optimal interprofessional collaboration between bedside nurses and attending physicians.
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