Interobserver reliability of attending physicians and bedside nurses when using an inpatient paediatric respiratory score

Eric A. Biondi, Julie Albright Gottfried, Irene Dutko Fioravanti, Jan A. Schriefer, Claude Andrew Aligne, Michael S. Leonard

Research output: Contribution to journalArticle


Aims and objectives: This study aimed to determine the interobserver reliability between bedside nurses and attending physicians for a paediatric respiratory score as part of an asthma Integrated Care Pathway implementation. Background: An Integrated Care Pathway is one approach to improving quality of care for children hospitalised with asthma. Prior to implementation of the integrated care pathway, it was necessary to train nursing staff on the use of a respiratory assessment tool and to evaluate the interobserver reliability use of this tool. Design: Prospective study using a convenience sample of children hospitalised for a respiratory illness in an academic medical centre. Methods: The respiratory assessment used was the Paediatric Asthma Score. Bedside nurse-attending physician (27 different RNs and three attending paediatric hospitalists) pairs performed 71 simultaneous patient assessments on 20 patients. Intraclass correlation coefficient and kappa statistics were used to assess interobserver reliability. Results: The overall intraclass correlation coefficient was nearly perfect where κ = 0·95, 95% CI (0·92, 0·97) and overall kappa for reliability based on clinically relevant score breakpoints was also high with κ = 0·82, 95% CI (0·75, 0·90). The majority of subgroup analyses revealed substantial to almost perfect agreement across a variety of diagnoses, age ranges, and individual score components. Conclusions: Bedside nurses, with support and training from attending physicians, can perform respiratory assessments that agree almost perfectly with those of attending physicians. Relevance to clinical practice: The use of an Integrated Care Pathway allows for optimal interprofessional collaboration between bedside nurses and attending physicians.

Original languageEnglish (US)
Pages (from-to)1320-1326
Number of pages7
JournalJournal of clinical nursing
Issue number9-10
StatePublished - May 1 2015
Externally publishedYes


  • Asthma
  • Paediatric
  • Reliability
  • Score

ASJC Scopus subject areas

  • Nursing(all)

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