Do medical students recognise the deteriorating patient by analysing their vital signs? A monocentric observational study based on the National Early Warning Score 2

Abstract

ObjectiveAssessment of the expertise of medical students in evaluating vital signs and their implications for the current risk of a patient, an appropriate monitoring frequency, and a proper clinical response.Methods251 second-year and 267 fifth-year medical students in a curriculum consisting of 6 years of medical school at Ulm University, Germany, were interviewed in a paper-based questionnaire. The students were asked to rate their proficiency in interpreting vital signs and to give pathological thresholds of vital signs. Based on the National Early Warning Score 2 (NEWS2), nine vital signs of fictional patients were created and students were asked to comment on their clinical risk, to set an appropriate monitoring frequency as well as a clinical response.ResultsInterviewing medical students regarding each vital sign individually, the students indicated a pathological threshold in accordance with the NEWS2 for respiratory rate, temperature, and heart rate. By contrast, inappropriate pathological limits were given regarding oxygen saturation and systolic blood pressure. Translating the vital signs into nine fictional patients, fifth-year medical students overall chose an appropriate response in 78% (67%−78%, median±IQR). In detail, fifth-year students successfully identified patients at very high or low risk and allocated them accordingly. However, cases on the edge were often stratified inappropriately. For example, a fictional case with vital signs indicating a surging sepsis was frequently underappreciated (48.5%) and allocated to an insufficient clinical response by fifth-year students.ConclusionsRecognising the healthy as well as the deteriorating patient is a key ability for future physicians. NEWS2-based education might be a valuable tool to assess and give feedback on student’s knowledge in this vital professional activity.

Aplicativo móvel Nursing Alert® para apoio ao enfermeiro na identificação da deterioração clínica do paciente

“…Dado que pacientes graves e com risco de morte necessitam de assistência privativa do enfermeiro, observa-se que a identificação precoce quanto à deterioração clínica se faz fundamental 27 . Todavia, desenvolver conhecimentos e habilidades para prestar assistência aos pacientes em deterioração clínica é um desafio na formação e aprimoramento profissional 12 . Aprofundar-se no reconhecimento da deterioração clínica, assim como habilidades em seu gerenciamento e desenvolvimento do trabalho em equipe, por exemplo, são apontados como temas a serem desenvolvidos com os enfermeiros 28 .…”

“…Escores têm sido usados não só para a predição da deterioração clínica 8,10 em pacientes internados em unidades clínicas, mas também para planejar a sua alta após internação em Unidade de Terapia Intensiva (UTI) 9 ou prever a necessidade de sua readmissão 11 . Treinamento de estudantes de medicina no reconhecimento da deterioração clínica 12 , promoção de resposta objetiva e sistemática 10 , além da sua aplicabilidade universal e o potencial de automatização 10 também têm sido potencialidades associadas aos escores de alerta precoce.…”