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Measuring Agreement Among Prehospital Providers and Physicians in Patient Capacity Determination
Author(s) -
O'Connor Laurel,
Porter Liam,
Dugas Julianne,
Robinson Conor,
Carrillo Eli,
Knowles Kenneth,
Nelson Kerrie P.,
Gigliotti Ronald,
Tennyson Joseph,
Weisberg Stacy,
Rebesco Matthew
Publication year - 2020
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13941
Subject(s) - medicine , kappa , emergency medical services , likert scale , cohen's kappa , emergency physician , inter rater reliability , medical emergency , emergency medicine , family medicine , emergency department , nursing , rating scale , philosophy , linguistics , statistics , mathematics , psychology , developmental psychology , machine learning , computer science
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.