Nurses’ judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores

•Agreement between nurses on patient risk of deterioration was fair to moderate.•Nurses agreed more between themselves than with early warning scores.•The correlation between nurses’ judgments and early warning scores was stronger on the surgical unit.•Nurses’ level of agreement did not differ depending on their first language, years of experience, or educational level. Nurses begin forming judgments regarding patients’ clinical stability during change-of-shift handoffs. To examine the agreement between incoming and outgoing nurses’ judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS). Following handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale. Sixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings. Nurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores.