Longitudinal analysis of one million vital signs in patients in an academic medical center

Bleyer, Anthony J.; Vidya, Sri; Russell, Gregory B.; Jones, Catherine M.; Sujata, Leon; Daeihagh, Pirouz; Hire, Donald

doi:10.1016/j.resuscitation.2011.06.033

Cited by 156 publications

(134 citation statements)

References 11 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…Even though changes in systolic blood pressure alone do not predict adverse events [45,46] , a decreased systolic blood pressure together with a decrease in urinary output, and/or respiratory changes and/or a decrease in consciousness is associated with a higher risk of death, as is a decreased systolic blood pressure with an abnormal blood gas analysis [46,47] . The low calling rate was also seen in case of decreased oxygen saturation and an increased heart rate.…”

Section: Discussionmentioning

confidence: 99%

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Simmes

Schoonhoven²,

Mintjes

et al. 2013

JHA

View full text Add to dashboard Cite

Objective: To describe the implementation of a rapid response system and adherence to its afferent limb in order to identify key elements for improvement. Implementation:We developed a multifaceted implementation strategy to introduce the Rapid Response System (RRS) on a 60-bed surgical ward of a university hospital. The strategy included the use of clear objectives, key leaders, an early warning score (EWS) observation protocol and a two-tiered medical emergency team (MET) warning protocol, a 1-day training program including a before-after knowledge test, mandatory for nurses and optional for ward physicians, reminders and feedback. Study design and methods:We retrospectively analyzed a sample of 10,653 patient days and 101 medical records of patients with a serious adverse event (SAE). Outcome measures were EWS recording rates, the nurse to ward physician and the ward physician to the MET calling rates following abnormal EWS recordings, and the indicators triggering these calls.Results: EWS recordings were present in 90% of the day shifts, 88% of the evening shifts and 80% of the night shifts. EWSs were recorded at least once in 92/101 medical records in the three days before an SAE; in 91/101 records EWSs were abnormal at least once. In case of an abnormal score, the nurse called the ward physician once or more in 87% (79/91). After being called by the nurse, the ward physician called the MET once or more in 75% (59/79). However, in 18% (15/79) there was a delay of one or two days before the ward physician/MET was called. Overall, medical emergency team calls were absent or delayed in over 50%. Conclusions:After RRS implementation, recording of the EWS was high. Adequate warning in case of abnormal scores was suboptimal in nurses as well as ward physicians. Future implementation strategies should therefore be aimed at the interdisciplinary team.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Simmes

Schoonhoven²,

Mintjes

et al. 2013

JHA

View full text Add to dashboard Cite

show abstract

“…Advanced age is independently associated with death and cardiac arrest, and use of age further improves predictive accuracy of many of the physiology based risk models (117)(118)(119)(120)(121)(122).…”

Section: Physiologicalmentioning

confidence: 99%

Frailty Assessment in Acute Care

2015

The Gerontologist

View full text Add to dashboard Cite

IntroductionFor some people, ageing is associated with the experience of increased co-morbidity, functional impairment, poor resilience and heightened vulnerability to external stressors, resulting in reduced lifespan as well as health-span. This frailty phenomenon poses challenges to health care systems in the form of increased patient complexity and resource utilisation. The acute care setting, characterised by time-pressure and high patient turn-over, is under strain and struggles to recognise and subsequently reliably intervene, to prevent, reverse or halt the decline of this vulnerable cohort. MethodsThis mixed-methods study probes existing evidence and 'real-world' processes with a systematic review of frailty assessments developed or validated in the acute care setting and a survey of contemporaneous clinical practice in London Acute Medical Units. Content validation and understanding of contextual factors for ideal frailty assessment in acute care is explored using Delphi consensus and Focus Group methodology respectively. The resultant model is developed on existing retrospective national Hospital Episode Statistics data, and prospectively tested on observational data in a local Acute Medical Unit setting. ResultsExisting frailty scores are preponderantly biophysical in nature, and have poor predictive power for adverse outcomes in the acute care setting. In clinical practice, single-dimension assessment tools predominate. Frailty syndromes and previous high resource utilisation in the form of a simple, clinically relevant tool useful to the multidisciplinary team gain consensus as optimal assessment for the setting. Retrospective testing of the frailty model displays moderate predictive powers for adverse events (inpatient mortality, emergency readmission and institutionalisation) and prospective testing provides concurrent (Frailty Index, Age, Co-Morbidity) and comparative predictive validity (Frailty Index, Co-Morbidity, 2 admission National Early Warning Score) with existing risk stratification models in this setting. ConclusionsA risk prediction model based on frailty syndromes and previous high resource utilisation is a valid, feasible and useful for the acute care setting.

show abstract

“…3 Large single-centre studies have demonstrated relationships between abnormalities in routinely measured vital signs and serious outcomes including death, unanticipated ICU admission and inhospital cardiac arrest (IHCA). 4,5 Abnormal vital signs are common before in-hospital cardiac arrest (IHCA) [6][7][8] and appear to predict progression to IHCA. 9,10 Research reported by Andersen and colleagues in this issue of Resuscitation adds to our understanding of the relationship between vital signs and outcomes.…”

mentioning

confidence: 99%

“…13 However, the ability to detect either vita signs abnormalities or associated changes in a timely fashion will be closely related to the frequency of vital signs monitoring, which may be variable or inadequate. 14,15 That vital signs abnormalities are predictive of IHCA outcome is not surprising, given that research has already established the strong relationship between such abnormalities and death, 4,5,18 and that the majority of patients having an IHCA die prior to hospital discharge. 12,17 However, the current research builds upon findings from single-site studies from Finland and the UK, where cardiac arrests with no pre-arrest vital sign abnormalities were associated with better survival than those where they were present.…”

mentioning

confidence: 99%

“…The study reports the mortality associated with incremental values for only heart rate, respiratory rate and systolic blood pressure, whereas it is known that the values of diastolic blood pressure, S p O 2 , conscious level and temperature also influence outcome. 4,5,9,10,16 Importantly, the study provides no information about responses to the abnormal vital signs; nor does it gives details of intra-arrest interventions or decision-making, both of which may influence the relationship between pre-arrest vital signs and post-arrest outcome. These omissions pose a number of interesting questions:…”

mentioning

confidence: 99%

See 1 more Smart Citation