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Related Experiment Video

Updated: Dec 30, 2025

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Developing the Synergy Model Patient Acuity Tool for Admission, Discharge, and Transfer.

Diane G Byrum1, Eileen V Caulfield2, Julia D Burgess3

  • 1Diane G. Byrum is a quality implementation consultant at Innovative Solutions for Healthcare Education, LLC, Charlotte, North Carolina.

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses
|January 23, 2020
PubMed
Summary

The Admission Discharge Transfer-Synergy Model Acuity Tool (ADT-SMAT) shows strong reliability for assessing critically ill patients. Further testing is needed to confirm its validity in predicting care levels for admission, discharge, and transfer.

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Area of Science:

  • Nursing
  • Critical Care Medicine
  • Healthcare Acuity Measurement

Background:

  • The Admission Discharge Transfer-Synergy Model Acuity Tool (ADT-SMAT) was developed based on the American Association of Critical-Care Nurses Synergy Model.
  • It aims to quantify patient intervention intensity, response variability, and nurses' critical thinking.

Purpose of the Study:

  • To determine the reliability and validity of the ADT-SMAT.
  • To assess its predictive capability for care levels in critically ill patients during admission, discharge, and transfer.

Main Methods:

  • Interrater reliability, intraclass coefficient, and effect size analyses were used.
  • 246 critically ill patients were evaluated for physiological variables and total ADT-SMAT scores.
  • Content and construct validity were assessed through consultation with nurses and correlation with other constructs.

Main Results:

  • The ADT-SMAT demonstrated strong reliability with an intraclass coefficient of 0.930.
  • Effect size analyses (Cohen d < 0.20) indicated minimal scoring differences.
  • The study identified a need for further testing to establish the ADT-SMAT's validity.

Conclusions:

  • This study is the first to correlate Synergy Model patient characteristics and acuity with nurses' decision-making.
  • The ADT-SMAT has the potential to quantify and standardize patient characteristics for care level determination.
  • Additional validation is recommended for the ADT-SMAT to become a valuable clinical tool.