Workload involved in vital signs-based monitoring & responding to deteriorating patients: A single site experience from a regional New Zealand hospital

Abstract

Objective: This study aimed to quantify the workload involved in patient monitoring by vital signs and early warning scores (EWS), and the time spent by a rapid response team locally known as the Patient-at-Risk (PaR) team in responding to deteriorating patients. Methods: The workload involved in the measurement and the documentation of vital signs and EWS was quantified by time and motion study using electronic stopwatch application in 167 complete sets of vital signs observations taken by nursing staff on general hospital wards at Taranaki Base Hospital, New Plymouth, New Zealand. The workload involved in responding to deteriorating patients was measured by the PaR team in real-time and recorded in an electronic logbook specifically designed for this purpose. Dependent variables were studied using analysis of variance (ANOVA), post hoc Tukey, Kruskal Wallis test, Mann-Whitney test and correlation tests. Results: The mean time to measure and record a complete set of vital signs including interruptions was 4:18 (95% CI: 4:07–4:28) minutes. After excluding interruptions, the mean time taken to measure and record a set of vital signs was 3:24 (95% CI: 3:15–3:33) minutes. We found no statistical difference between the observer, location of the patient, staff characteristics or experience and patient characteristics. PaR nurses' mean time to provide rapid response was 47:36 (95% CI: 44:57–50:15) minutes. Significantly more time was spent on patients having severe degrees of deterioration (higher EWS) < 0.001. No statistical difference was observed between ward specialty, and nursing shifts. Conclusions: Patient monitoring and response to deterioration consumed considerable time. Time spent in monitoring was not affected by independent and random factors studied; however, time spent on the response was greater when patients had higher degrees of deterioration.

Keywords

• Patient monitoring
• Patient deterioration
• Vital signs
• Early warning score
• Escalation of care
• Rapid response system