Looking Good From the End of Bed: Surgical Clinical Intuition

This study sought to assess clinician ability to correctly identify unwell surgical patients from the 'end-of-bed' to determine the validity of this commonly utilised clinical tool, and whether accurate assessment increases with experience.

This prospective observational study recruited patients at the time of surgical admission. Patients were filmed responding to three standard questions concerning their presentation. Each patient video was then viewed by five participants from various groups: surgical consultants, registrars, interns, medical students and orderlies (control group). Five 'Yes/No' questions were answered for each video, regarding how unwell patients appeared and their likely clinical trajectory. Assessor answers were compared with 'correct' answers as determined by the investigators, utilising patient clinical data. For each group, the percentage of questions answered correctly was calculated across 99 patients. The mean and standard deviation for the percentage correct was calculated as well as Cohen's Kappa Score when comparing the score for each assessor group with the 'correct' answer.

The percentage of correctly answered questions was highest in the registrar group (82.21%), closely followed by consultants (82.04%), interns (80.47%), medical students (79.74%) and orderlies (79.44%) (p values < 0.001, except students' p value 0.0729). The order of Cohen's Kappa for correctly answered questions found consultants to have the highest agreement (0.26-fair agreement), followed by registrars (0.25-fair agreement) and lastly medical students (0.14-slight agreement) (p values < 0.001).

The 'end-of-bed' assessment is a potential initial tool for assessing disease severity and clinical trajectory of surgical patients and improves with clinician experience.