Vital Signs: How Often is Too Often?
Monitoring vital signs (e.g., blood pressure, heart rate, oxygen level and temperature) in acute care hospital settings is a crucial aspect of providing safe patient care. Acutely ill individuals need to have their vital signs measured on a frequent basis, as changes in vital signs can signal that a patient's health has worsened. Research has demonstrated that using vital signs for early detection of patient deterioration results in statistically significant decreases in complications rates, transfers to higher levels of care and failure to rescue events. However, the uncertainty surrounding optimum monitoring frequencies, as well as their impact on nursing workload, makes precise workforce planning difficult.
Why Monitoring Vital Signs is Crucial
Like the lights on your car dashboard, vital signs are objective indicators of a living organism's general status and can be a signal of the development of an acute physiologic change such as a pulmonary embolism, or can demonstrate a trend that indicates the development of a chronic condition such as hypertension. Undetected and untreated chronic conditions such as hypertension, can lead to long term complications such as peripheral vascular disease, heart disease and stroke. Vital sign measurement is a critical first step in any clinical assessment, and without these basic physiologic indicators, the clinician is in the dark. So, with patient safety as a primary goal in every health care institution, prompt and efficient detection of a patient’s physiologic deterioration, whether the patient is in the emergency department or on a medical-surgical unit, is critical.
How Often Vital Signs Are Being Monitored in Low Activity
Due to heavy workloads, nurses frequently report missing crucial patient assessments: one recent study evaluated vital sign observations on 32 in-patient units and discovered that on average, 31.3% of required vital sign observations were delayed and 17.1% of the required vital sign observations were completely missed. Of those delayed or missed observations, 6% were preceded by a National Early Warning Score (NEWS) greater than 5 indicating a potential patient deterioration.
Vital signs are rarely continuously monitored outside of high-acuity environments such as Intensive Care and Acute Care Units. Instead, nursing staff measure and manually record patients' vital signs on a regular basis, often in accordance with physician orders or nursing policy and in conjunction with early deterioration assessment tools such as the National Early Warning Score.
Typically on general care wards, vital signs are taken every four hours but can be as far apart as 12 hours depending on the patient population. This frequency can change, depending on the nurse’s assessment of the patient’s physiologic status and any scores obtained using patient deterioration identification tools such as the National Early Warning Score.
In the United Kingdom, for example, the National Early Warning Score 2 system is recommended by national agencies for use in acute hospitals and has been adopted in the majority of settings. Those with a low National Early Warning Score are evaluated every 6-12 hours, whereas patients with scores above 6 are watched hourly.
Although routine four-hour assessments can result in non-actionable observations because the actionable events are occurring in between the observations, and more frequent monitoring may generate a large number of false warnings, potentially creating unnecessary work for nurses, vital sign monitoring is imperative when developing a workflow that focuses on patient safety and early identification of patient deterioration. However, identifying alternate vital signs monitoring regimens that result in a safe balance between identifying patient deterioration and optimizing nursing workflows continues to be difficult.
Continuous Vital Signs Monitoring Solution
There is a solution. In a 2022 study, the authors found that by using ViSi Mobile (a wearable surveillance monitor that continuously monitors all vital signs including blood pressure, alerts for lethal arrhythmias, and has features such as fall detection, and transmits vital sign data to the electronic medical record), they saw fewer ICU transfers, fewer rapid response calls, and of the rapid response calls that were activated, fewer “false alarms” were seen, improving overall efficiency of the rapid response system. A similar 2019 study also found that by using ViSi Mobile, they were able to decrease postoperative complication rates, transfers to ICU and Failure to Rescue (FTR) events.
This is where continuous vital signs monitoring with ViSi Mobile brings value to hospitals by being the balance between identifying patient deterioration and optimizing nursing workflows. ViSi Mobile offers just what the doctor ordered…continuous surveillance monitoring of patient's vital signs with real time alerts to clinical staff for early detection of patient deterioration and avoidance of any failure to rescue event.