PURPOSE: Physicians often assess subjective clinical variables and communicate them to team members in the course of making decision. These subjective variables are related to patient outcomes. The degree of agreement between physicians on these variables is unknown. We aim to examine the agreement between medical residents and critical care fellows on the subjective clinical variables when they evaluate patients for admission to the MICU.
METHODS: Residents and critical care fellows independently evaluated 247 patients for admission to the MICU. The subjective variables documented by them were: clinical course (improving, not deteriorating, deteriorating slowly, deteriorating rapidly), clinical stability (can take extreme stress, can take most stress, might have trouble with moderate stress, likely to have trouble with mild stress, likely to have trouble without stress), respiratory status (no, slight, moderate, severe respiratory difficulty), physical strength (strong, weak but able to do most activity, weak but can only do simple activity, incapacitated, flaccid) and agitation (none, mild, moderate, severe). PHI (chance independent agreement) was calculated for the resident-fellow pairs separately for evaluations that occurred within 60 minutes and > 60 minutes apart.
RESULTS: Agreement was higher when the evaluations occurred within 60 minutes than when the evaluations occurred > 60 minutes apart. When the evaluations occurred within 60 minutes, agreement was highest for physical strength (0.56) and lowest for agitation (0.38). When the evaluations occurred > 60 minutes apart, agreement was highest for respiratory status (0.38) and lowest for agitation (0.01) and physical strength (0.01).
CONCLUSION: For most subjective clinical variables, agreement is weak and worsens over time.
CLINICAL IMPLICATIONS: Physician at different levels of experience should be cautioned when they communicate subjective clinical variables of patients evaluated for possible admission to the MICU.
DISCLOSURE: Aiyub Patel, No Financial Disclosure Information; No Product/Research Disclosure Information