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The Language of Sickness: Indexing patients at the Intersection of Patient Assessment Scores

Posted 21 June 2021

Patient assessment scores exist to stratify patients traditionally by using specific anatomical and physiological indices. An assessment score can help the health care team determine the appropriate triage, aid in decision-making through standardization of clinical findings, and objectively score the severity of the patient’s illness or injury.

A Snapshot of Patient Assessment Scores

Patient assessment scores are used throughout the healthcare continuum from nurse to physician and from outpatient to inpatient. Some scores inform decision-making, such as the Braden Scale, Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-AR), or the Modified Early Warning Score (MEWS). In contrast, others assess the severity of illness or injuries, like the National Institutes of Health Stroke Score (NIHSS), Glasgow Coma Scale (GSC), and Injury Severity Score (ISS).

A Common Language of Sickness

These scores exist as a universal language in medicine: Without having fluency in each other’s mother tongue, a healthcare professional in rural Kansas and urban New Delhi would understand a patient with a GCS of 7 or an ISS of 15.

These internationally recognized patient assessment scores allow healthcare professionals to gauge patients’ clinical conditions and potential needs based on units of physiological data. Others exist to assist in care decision-making within a specific scenario. Still, no current methods exist for identifying and quantifying into a common language the elements of a patient’s condition when hospital transfer is needed.

A Remaining Utility Exists Despite Score Saturation

With this wealth of scoring methodologies, a natural saturation occurs: How many is too many? Scoring system fatigue occurs, and some scores are naturally weeded out according to how much utility they provide. Certain scoring systems become mainstream while others get left behind because there are simply too many, too complex, or used in such rare circumstances that their lack of utility is the cause of their extinction.

However, none of the current scoring methodologies illuminate the unique variables and considerations inherent to adult interfacility transfers. Removing a patient from the resource-rich environment of a hospital setting requires a practical understanding of the level of care necessary during transport to maintain established stability, and the risk of patient deterioration outside the environs of a hospital, along with identifying the severity of illness or injury.

Interfacility Transport: Measuring More Than Miles

One of the current gaps in interfacility patient transport is not having guidance to clinical scoring that assesses the illness and injury severity and risk when taken out of the resource-rich environment of an ED or hospital bed. What is the best type of transport for a patient who needs a neurological intervention 60 miles away versus a non-time critical orthopedic injured patient at the same facility and their receiving hospital is 200 miles away? Before deciding on BLS, ALS, or critical care, air or ground, what questions must be answered?

The Acuity Index: Capturing Severity of Illness, Level of Care Needs, and Risk for Deterioration During Transfer

The lack of a method to objectively quantify the nuances present in adult interfacility patient transfers has created the need for the Acuity Index. The Acuity Index is based on decades of emergency medicine and medical transport experience specific to the context of emergent interfacility patient transfers.

The Acuity Index addresses the question of “how sick is this patient,” which informs the level or urgency in moving the patient to definitive care and the risk of patient deterioration during the transport process by capturing information in three key areas to guide transfer decisions.

1. Level of care that will be needed at the destination facility and time criticality of the working diagnosis

2. Physiological support or intervention that has been instituted to maintain patient stability

3. Common factors that contribute to the risk of deterioration during transfer

The information gathered under these categories stratifies and assigns a numerical value to each patient. The value reflects both the patient’s illness level or severity along with the level of care needed in the transfer process such that the patient maintains or ascends the level of care ladder through this acute phase of their clinical journey.

Creating a Common Language for Interfacility Patient Transfer

The value of the Acuity Index score is specific to patient movement. Other scoring systems can measure patient conditions and influence treatment options for future research, outcome measurement, and reimbursement purposes. The Acuity Index explicitly scores a patient’s condition as appropriate for transport between the sender, EMS services, and the receiver. It has a specific use and value applied directly to patient movement.

The Acuity Index introduces another language for the medical world in a transfer scoring system. However, instead of increasing saturation, the Acuity Index fills a much-needed gap: The Acuity Index asks eight questions, broken into three parts, to determine patient level of care, physiological support, and risk of deterioration. The Acuity Index asks straightforward questions that consider clinical workload, risk, transport, a prognostic perspective of the patient, all critical components of moving the patient between controlled and uncontrolled environments.

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