Assistant Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, AL and Birmingham VA Medical Center, Birmingham, AL.
J Nurs Scholarsh. 2014 Mar;46(2):98-105. doi: 10.1111/jnu.12060. Epub 2013 Dec 19.
One of the most commonly performed task in the emergency department (ED) is reported as the monitoring of vital signs, yet there are no published standards of care that provide guidelines for the frequency of obtaining vital signs in the ED. The purpose of this exploratory study was to determine the frequency of documentation of vital signs recorded during ED visits across Veterans Health Administration (VHA) facilities.
Deidentified patient level data from the VHA electronic health record (EHR) were abstracted for emergency department visits for 12 randomly selected days in calendar year 2011. The dataset included vital signs data, associated time stamps, facility, length of stay, triage category based on the Emergency Severity Index (ESI), and patient disposition for all patients. Descriptive statistics were used to describe the frequency of the specific vital sign measures, and parametric and nonparametric tests were used to examine study variables by ESI.
The sample consisted of over 43,232 unique patient visits to 94 VHA EDs with a median length of stay of 173.3 min (interquartile range [IQR], 96.1-286.9). The mean number of times that blood pressure (BP) was recorded per visit was 1.23 (SD 1.175). For the entire sample, median time between blood pressure measurements was 139.7 min (IQR, 81.6-230.1). There was a significant difference in median length of stay and median time between blood pressure by ESI category.
In this dataset, median time between documentation of BP in the ED was every 2.3 hr for all patients. While the median time was statistically significant between ESI categories, these times may not be clinically relevant. More important was the inconsistent documentation of vital signs of ED patients in the designated fields in the EHR. Most facilities (84.1%) documented BP for >75% of patient visits. However, eight facilities (9.1%) had BP documented in <50% of patient visits.
It seems unlikely that vital signs are not monitored in the ED; nurses anecdotally report that vital signs are recorded on a paper chart and later scanned as an image into the EHR. However, lack of consistent process in documentation of vital signs may decrease the care team's ability to note early warning signs of physiological instability or deterioration.
在急诊科（ED）中最常执行的任务之一是监测生命体征，但目前尚无提供 ED 中获取生命体征频率指南的护理标准。本探索性研究的目的是确定退伍军人健康管理局（VA）设施中记录的 ED 就诊时生命体征记录的频率。
从 VA 电子健康记录（EHR）中提取了 12 个随机选定日期的急诊就诊患者的匿名患者水平数据。该数据集包括生命体征数据、相关时间戳、设施、根据紧急严重指数（ESI）分类的住院时间、就诊分类和所有患者的处置。使用描述性统计来描述特定生命体征测量的频率，并使用参数和非参数检验按 ESI 检查研究变量。
样本由 94 个 VA ED 中 43,232 名独特患者就诊组成，中位数住院时间为 173.3 分钟（四分位距 [IQR]，96.1-286.9）。每次就诊记录血压（BP）的次数平均值为 1.23（SD 1.175）。对于整个样本，BP 测量之间的中位数时间为 139.7 分钟（IQR，81.6-230.1）。ESI 类别之间的中位住院时间和 BP 测量之间的中位数时间存在显著差异。
在这个数据集，ED 中 BP 的记录中位数时间为每位患者每 2.3 小时记录一次。虽然 ESI 类别之间的中位数时间存在统计学差异，但这些时间可能在临床上并不相关。更重要的是，ED 患者的生命体征在 EHR 指定字段中的记录不一致。大多数设施（84.1%）记录了超过 75%的患者就诊时的 BP。然而，有 8 个设施（9.1%）记录的 BP 少于 50%的患者就诊。
ED 中似乎没有监测生命体征；护士们凭经验报告说，生命体征记录在纸质图表上，然后扫描成 EHR 的图像。然而，生命体征记录缺乏一致的流程可能会降低护理团队注意生理不稳定或恶化的早期预警信号的能力。
