Inter‐Rater Reliability of the Hemodialysis Acuity Tool for Assessing Patient Care Acuity (the HAT Study)

BACKGROUND: In Australian hemodialysis settings, the absence of a validated, localized tool to measure patient acuity has resulted in allocation based on hemodialysis chairs availability rather than objective assessment. To address this gap, the Hemodialysis Acuity Tool (HAT) was developed to evaluate patient acuity and determine suitability for specific hemodialysis locations. AIM: This study aims to assess the inter-rater reliability of the HAT to support hemodialysis nurses in assessing patient care acuity and identifying optimal hemodialysis setting for adults receiving hemodialysis. METHODS: A prospective observational study examined the use of HAT by hemodialysis nurses to assess patient care acuity. Inter-rater reliability was tested by comparing scores assigned by different hemodialysis nurses. Statistical analysis was performed using descriptive statistics and intraclass correlation coefficient. RESULTS: Intraclass correlation coefficient indicated moderate to good inter-rater reliability for the categories of physical and psychosocial and the overall total patient scores, though no correlation was found in the hemodialysis category or comorbidity at month 6. CONCLUSION: The HAT demonstrates potential as a reliable tool for determining patient suitability for specific hemodialysis locations and identifying candidates for home hemodialysis or additional support. Its use can facilitate safe allocation of patients to units equipped with appropriate resources, improving care delivery and supporting workforce planning.