The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope

Anna Marie Chang; Judd E. Hollander; Erica Su; Robert E. Weiss; Annick N. Yagapen; Susan E. Malveau; David H. Adler; Aveh Bastani; Christopher W. Baugh; Jeffrey M. Caterino; Carol L. Clark; Deborah B. Diercks; Bret A. Nicks; Daniel K. Nishijima; Manish N. Shah; Kirk A. Stiffler; Alan B. Storrow; Scott T. Wilber; Benjamin C. Sun

doi:10.1016/j.jemermed.2020.02.020

The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope

Anna Marie Chang, Judd E. Hollander, Erica Su, Robert E. Weiss, Annick N. Yagapen, Susan E. Malveau, David H. Adler, Aveh Bastani, Christopher W. Baugh, Jeffrey M. Caterino, Carol L. Clark, Deborah B. Diercks, Bret A. Nicks, Daniel K. Nishijima, Manish N. Shah, Kirk A. Stiffler, Alan B. Storrow, Scott T. Wilber, Benjamin C. Sun

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. Objective: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. Methods: We conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. Results: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2–71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9–63.6%) and the specificity was 47.8% (95% confidence interval 45.0–50.5%). Conclusions: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.

Original language	English (US)
Pages (from-to)	193-200
Number of pages	8
Journal	Journal of Emergency Medicine
Volume	59
Issue number	2
DOIs	https://doi.org/10.1016/j.jemermed.2020.02.020
State	Published - Aug 2020

Keywords

InterQual
case management
geriatrics
syncope

ASJC Scopus subject areas

Emergency Medicine

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Chang, A. M., Hollander, J. E., Su, E., Weiss, R. E., Yagapen, A. N., Malveau, S. E., Adler, D. H., Bastani, A., Baugh, C. W., Caterino, J. M., Clark, C. L., Diercks, D. B., Nicks, B. A., Nishijima, D. K., Shah, M. N., Stiffler, K. A., Storrow, A. B., Wilber, S. T., & Sun, B. C. (2020). The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope. Journal of Emergency Medicine, 59(2), 193-200. https://doi.org/10.1016/j.jemermed.2020.02.020

The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope. / Chang, Anna Marie; Hollander, Judd E.; Su, Erica; Weiss, Robert E.; Yagapen, Annick N.; Malveau, Susan E.; Adler, David H.; Bastani, Aveh; Baugh, Christopher W.; Caterino, Jeffrey M.; Clark, Carol L.; Diercks, Deborah B.; Nicks, Bret A.; Nishijima, Daniel K.; Shah, Manish N.; Stiffler, Kirk A.; Storrow, Alan B.; Wilber, Scott T.; Sun, Benjamin C.

In: Journal of Emergency Medicine, Vol. 59, No. 2, 08.2020, p. 193-200.

Research output: Contribution to journal › Article › peer-review

Chang, AM, Hollander, JE, Su, E, Weiss, RE, Yagapen, AN, Malveau, SE, Adler, DH, Bastani, A, Baugh, CW, Caterino, JM, Clark, CL, Diercks, DB, Nicks, BA, Nishijima, DK, Shah, MN, Stiffler, KA, Storrow, AB, Wilber, ST & Sun, BC 2020, 'The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope', Journal of Emergency Medicine, vol. 59, no. 2, pp. 193-200. https://doi.org/10.1016/j.jemermed.2020.02.020

Chang, Anna Marie ; Hollander, Judd E. ; Su, Erica ; Weiss, Robert E. ; Yagapen, Annick N. ; Malveau, Susan E. ; Adler, David H. ; Bastani, Aveh ; Baugh, Christopher W. ; Caterino, Jeffrey M. ; Clark, Carol L. ; Diercks, Deborah B. ; Nicks, Bret A. ; Nishijima, Daniel K. ; Shah, Manish N. ; Stiffler, Kirk A. ; Storrow, Alan B. ; Wilber, Scott T. ; Sun, Benjamin C. / The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope. In: Journal of Emergency Medicine. 2020 ; Vol. 59, No. 2. pp. 193-200.

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title = "The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope",

abstract = "Background: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. Objective: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. Methods: We conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. Results: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2–71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9–63.6%) and the specificity was 47.8% (95% confidence interval 45.0–50.5%). Conclusions: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.",

keywords = "InterQual, case management, geriatrics, syncope",

author = "Chang, {Anna Marie} and Hollander, {Judd E.} and Erica Su and Weiss, {Robert E.} and Yagapen, {Annick N.} and Malveau, {Susan E.} and Adler, {David H.} and Aveh Bastani and Baugh, {Christopher W.} and Caterino, {Jeffrey M.} and Clark, {Carol L.} and Diercks, {Deborah B.} and Nicks, {Bret A.} and Nishijima, {Daniel K.} and Shah, {Manish N.} and Stiffler, {Kirk A.} and Storrow, {Alan B.} and Wilber, {Scott T.} and Sun, {Benjamin C.}",

year = "2020",

month = aug,

doi = "10.1016/j.jemermed.2020.02.020",

language = "English (US)",

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pages = "193--200",

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T1 - The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope

AU - Chang, Anna Marie

AU - Hollander, Judd E.

AU - Su, Erica

AU - Weiss, Robert E.

AU - Yagapen, Annick N.

AU - Malveau, Susan E.

AU - Adler, David H.

AU - Bastani, Aveh

AU - Baugh, Christopher W.

AU - Caterino, Jeffrey M.

AU - Clark, Carol L.

AU - Diercks, Deborah B.

AU - Nicks, Bret A.

AU - Nishijima, Daniel K.

AU - Shah, Manish N.

AU - Stiffler, Kirk A.

AU - Storrow, Alan B.

AU - Wilber, Scott T.

AU - Sun, Benjamin C.

PY - 2020/8

Y1 - 2020/8

N2 - Background: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. Objective: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. Methods: We conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. Results: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2–71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9–63.6%) and the specificity was 47.8% (95% confidence interval 45.0–50.5%). Conclusions: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.

AB - Background: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. Objective: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. Methods: We conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. Results: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2–71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9–63.6%) and the specificity was 47.8% (95% confidence interval 45.0–50.5%). Conclusions: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.

KW - InterQual

KW - case management

KW - geriatrics

KW - syncope

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