The Constant Observation Resource Assessment (CORA): A Preliminary Tool Evaluation

OBJECTIVE: The Constant Observation Resource Assessment (CORA) was developed to guide prioritization of resources. INTRODUCTION: Constant observers, also called patient safety attendants, support safe, less restrictive care for high-risk patients. Staffing shortages highlight the need for structured, equitable constant observation (CO) allocation. METHODS: In this prospective pilot on 15 adult and 4 pediatric units, researchers evaluated CORA's content validity and inter-rater reliability. Over 6 months in 2021, nurses completed pre-/postimplementation surveys on transparency, fairness, accuracy, and confidence in allocation. A subset of assessments was dual-rated within the same shift to calculate the interclass correlational coefficient (ICC) (2,1). RESULTS: Staff ratings improved across all domains (P≤0.002; Cohen's d ≈ 0.74-1.31). Among 600 assessments, the total score ICC(2,1) was 0.717 [95% CI (0.647, 0.775)]; subscales ranged from 0.607 to 0.720. Cronbach's α was 0.888 (raw). CONCLUSIONS: CORA showed acceptable inter-rater reliability and initial validity, supporting its potential to standardize CO allocation. The CORA tool offers a standardized, evidence-based approach to allocating CO resources, addressing long-standing concerns about fairness and transparency in sitter assignments. Its implementation may improve patient safety, support clinical decision-making, and reduce burden on nursing staff in high-acuity inpatient settings. Future studies will assess predictive performance and refine decision thresholds.