Monitoring patients’ vital signs (such as blood pressure, oxygen levels and pulse) is a fundamental part of clinical care in hospital. Failure to monitor vital signs, and act when they indicate the patient's condition is deteriorating, has been identified as a safety issue for some time. Early Warning Scores (EWS) are now recommended as part of the recognition and response to patient deterioration, and EWS can identify patients at risk of adverse outcomes, such as cardiac arrest, unanticipated intensive care unit admission or death.
This study will examine trends and variation in vital signs of patients on admission to hospital, with a particular focus on patients who have been admitted in an emergency. The project builds on the Nuffield Trust’s programme of work on the quality of care of medical patients, and addresses growing national concern about increases in emergency admissions and the care of patients with long lengths of stay in hospital.
This research will provide insights that will help national policy makers determine the scope to reduce length of stay. The study will also provide useful intelligence for participating organisations by giving them a picture of their patient population.
Using electronically captured vital signs data (via CareFlow Vitals, formerly known as VitalPAC) already collected as part of routine care, analysis will be undertaken to address three research questions:
- Has there been a change over time in the threshold for emergency admission to hospital, as indicated by physiological stability (EWS) of patients admitted?
- Do emergency patient admissions at the weekend have a different physiological profile to those admitted on weekdays?
- What is the physiological stability over the course of hospital stay of patients who have a length of stay in hospital of more than 5 days?
We are currently working with a small number of organisations to enrol them in the study, and agree robust arrangements for accessing observation data. The analysis phase is expected to take place during summer 2019, and the project is expected to be complete by the end of 2019.