Title

Measuring Agreement Among Prehospital Providers and Physicians in Patient Capacity Determination

UMMS Affiliation

Department of Emergency Medicine

Publication Date

2020-02-17

Document Type

Article

Disciplines

Emergency Medicine | Health Services Administration

Abstract

OBJECTIVES: If a patient wishes to refuse treatment in the prehospital setting, prehospital providers and consulting emergency physicians must establish that the patient possesses the capacity to do so. The objective of this study is to assess agreement among prehospital providers and emergency physicians in performing patient capacity assessments.

METHODS: This study involved 139 prehospital providers and 28 emergency medicine physicians. Study participants listened to 30 medical control calls pertaining to patient capacity and were asked to interpret whether the patients in the scenarios had the capacity to refuse treatment. Participants also reported their comfort level using modified Likert scales. Inter-rater reliability was calculated utilizing Fleiss' and Model B kappa statistics. Fisher's exact tests were used to calculate p-values comparing the proportion in each cohort that responded "no capacity." Primary outcomes included inter-rater reliability in the physician and prehospital provider cohorts.

RESULTS: The inter-rater agreement between the physicians was low (Fleiss' kappa = 0.31, standard error [SE] =0.06; model-based kappa = 0.18, SE = 0.04). Agreement was similarly low for the 135 prehospital providers (Fleiss' kappa = 0.30, SE = 0.06; model-based kappa = 0.28, SE = 0.04). The difference between the proportion of physicians and prehospital providers who responded "no capacity" was statistically significant in five of 30 scenarios. Median prehospital provider and physician confidence, on a 1 to 4 scale, was 2.00 (Q1-Q3 = 1.00-3.00 for prehospital providers and Q1-Q3 =1.0-2.0 for physicians).

CONCLUSIONS: There was poor inter-rater reliability in capacity determination between and among the prehospital provider and physician cohorts. This suggests that there is need for additional study and standardization of this task.

DOI of Published Version

10.1111/acem.13941

Source

O'Connor L, Porter L, Dugas J, Robinson C, Carrillo E, Knowles K, Nelson KP, Gigliotti R, Tennyson J, Weisberg S, Rebesco M. Measuring Agreement Among Prehospital Providers and Physicians in Patient Capacity Determination. Acad Emerg Med. 2020 Feb 17. doi: 10.1111/acem.13941. Epub ahead of print. PMID: 32065493. Link to article on publisher's site

Journal/Book/Conference Title

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Related Resources

Link to Article in PubMed

PubMed ID

32065493

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