Usability of the Surprise Question by Nurses and Patients’ Families for Risk Stratification in Emergency Patients: A Prospective Cohort Study

The Surprise Question is an effective tool to identify patients in need of palliative care. But it is unknown whether the Surprise Question can effectively predict adverse outcomes in Emergency patients. Therefor this study is to determine the utility of the modified Surprise Question for risk stratification in emergency patients. And assessed if the modified Surprise Question could be used by different healthcare personnel. Nurses and patients’ families were asked to respond as “Yes” or “No” to the modified Surprise Question for each patient. The outcome was resuscitation unit admission. Logistic regression was used to determine covariant significantly associated with resuscitation unit admission. The area under the curve for the second Surprise Question response by nurses was 0.620, which improved to 0.704 when the responses of nurses and patients’ families were in agreement. The clinical impression of nurses is a valuable tool to predict altered conditions for medium-acuity patients, and the diagnostic accuracy improves when responses of patients’ families and nurses agreed. The clinical impression of nurses is a valuable tool to predict altered conditions for medium-acuity patients, and the diagnostic accuracy improves when responses of patients’ families and nurses agreed.

[1]  C. Moor,et al.  The Value of the Surprise Question to Predict One-Year Mortality in Idiopathic Pulmonary Fibrosis: A Prospective Cohort Study , 2021, Respiration.

[2]  N. Van Den Noortgate,et al.  Prognostic value of the Surprise Question for one-year mortality in older patients: a prospective multicenter study in acute geriatric and cardiology units , 2020, Acta clinica Belgica.

[3]  B. Buurman,et al.  Usability of the surprise question by nurses to identify 12-month mortality in hospitalized older patients: A prospective cohort study. , 2020, International journal of nursing studies.

[4]  Wennv Hao,et al.  Factors associated with core competencies of emergency-room nurses in tertiary hospitals in China. , 2020, Japan journal of nursing science : JJNS.

[5]  F. Camacho,et al.  Validation of the surprise question in gynecologic oncology: A one-question screen to promote palliative care integration and advance care planning. , 2020, Gynecologic oncology.

[6]  M. Supino,et al.  Would You Be Surprised if This Patient Died in the Next 12 Months? Using the Surprise Question to Increase Palliative Care Consults From the Emergency Department , 2020, Journal of palliative care.

[7]  Allen N. Gustin Shared Decision-Making. , 2019, Anesthesiology clinics.

[8]  Akihiro Sekine,et al.  Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department , 2019, PeerJ.

[9]  G. Collins,et al.  The National Early Warning Score 2 (NEWS2). , 2019, Clinical medicine.

[10]  V. Jackson,et al.  The Surprise Question Can Be Used to Identify Heart Failure Patients in the Emergency Department Who Would Benefit From Palliative Care. , 2019, Journal of pain and symptom management.

[11]  S. Haydar,et al.  Prognostic value of a modified surprise question designed for use in the emergency department setting , 2019, Clinical and experimental emergency medicine.

[12]  Tadahiro Goto,et al.  Emergency department triage prediction of clinical outcomes using machine learning models , 2019, Critical Care.

[13]  Song-Tao Shou,et al.  Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis , 2019, Internal and Emergency Medicine.

[14]  P. D. de Leeuw,et al.  Short-term mortality in older medical emergency patients can be predicted using clinical intuition: A prospective study , 2019, PloS one.

[15]  Colin A Graham,et al.  qSOFA is a Poor Predictor of Short-Term Mortality in All Patients: A Systematic Review of 410,000 Patients , 2019, Journal of clinical medicine.

[16]  H. Tam,et al.  A review of triage accuracy and future direction , 2018, BMC Emergency Medicine.

[17]  H. Lum,et al.  The Surprise Question as a Prognostic Tool #360. , 2018, Journal of palliative medicine.

[18]  Scott Levin,et al.  Machine‐Learning‐Based Electronic Triage More Accurately Differentiates Patients With Respect to Clinical Outcomes Compared With the Emergency Severity Index , 2017, Annals of emergency medicine.

[19]  P. Nanayakkara,et al.  Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review. , 2017, European journal of internal medicine.

[20]  Yuedong Wang,et al.  Performance of the Surprise Question Compared to Prediction Models in Hemodialysis Patients: A Prospective Study , 2017, American Journal of Nephrology.

[21]  P. Stone,et al.  How accurate is the ‘Surprise Question’ at identifying patients at the end of life? A systematic review and meta-analysis , 2017, BMC Medicine.

[22]  Marina F Englesakis,et al.  The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis , 2017, Canadian Medical Association Journal.

[23]  R. Bellomo,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). , 2016, JAMA.

[24]  Michael Casale,et al.  A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index , 2015, JMIR medical informatics.

[25]  R. Bingisser,et al.  Clinical intuition ratings are associated with morbidity and hospitalisation , 2015, International journal of clinical practice.

[26]  K. Farrington,et al.  How Robust Is the ‘Surprise Question' in Predicting Short-Term Mortality Risk in Haemodialysis Patients , 2013, Nephron Clinical Practice.

[27]  P. Tanabe,et al.  More patients are triaged using the Emergency Severity Index than any other triage acuity system in the United States. , 2012, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[28]  Jesse M Pines,et al.  International perspectives on emergency department crowding. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[29]  Gerard FitzGerald,et al.  Emergency department triage revisited , 2009, Emergency Medicine Journal.

[30]  J. Abraham,et al.  Prognostic significance of the "surprise" question in cancer patients. , 2010, Journal of palliative medicine.

[31]  Dominik Aronsky,et al.  Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. , 2009, Annals of emergency medicine.

[32]  H. V. van Stel,et al.  Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study , 2009, Emergency Medicine Journal.

[33]  Kenneth Bond,et al.  Tracking emergency department overcrowding in a tertiary care academic institution. , 2009, Healthcare quarterly.

[34]  R. Shelton The Emergency Severity Index 5-Level Triage System , 2009, Dimensions of critical care nursing : DCCN.

[35]  A. Moss,et al.  Utility of the "surprise" question to identify dialysis patients with high mortality. , 2008, Clinical journal of the American Society of Nephrology : CJASN.

[36]  Ouyporn Tonmukayakul,et al.  Development of competency inventory for registered nurses in the People's Republic of China: scale development. , 2007, International journal of nursing studies.

[37]  C. Subbe,et al.  Validation of a modified Early Warning Score in medical admissions. , 2001, QJM : monthly journal of the Association of Physicians.

[38]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.