The Admission Discharge Transfer–Synergy Model Acuity Tool (ADT-SMAT) was developed to quantify patient intervention intensity and patient response variability and to capture nurses’ critical thinking. The tool is based on the American Association of Critical-Care Nurses Synergy Model for Patient Care.


To determine whether the ADT-SMAT is reliable and valid for predicting the level of care for admission, discharge, and transfer of critically ill patients. Methods Reliability was examined by using interrater reliability, intraclass coefficient, and effect size analyses to evaluate physiological variables and total calculated ADT-SMAT score in 246 patients. Content validity was determined in consultation with critical care nurses, and construct validity was examined by assessing the correlation between ADT-SMAT scores and other convergent and divergent constructs.


The ADT-SMAT showed strong reliability for measuring the physiological variables and total score, with an intraclass coefficient of 0.930. The value of Cohen d determining the effect size for each element of the ADT-SMAT was less than 0.20 for every element, indicating that substantial differences in scoring did not occur. The validity of the ADT-SMAT requires additional testing.


This is the first study attempting to correlate Synergy Model patient characteristics and acuity while integrating nurses’ critical decision-making process. With further testing, the ADT-SMAT could be a valuable tool to quantify and standardize patient characteristics in determining the appropriate level of care associated with admission, discharge, and transfer decisions.

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