Abstract
Objective
To study the rate of documentation of vital signs in the period before the occurrence
of an adverse event or emergency team call and to measure the effect of introducing
the medical emergency team (MET) system on the rate of such documentation.
Methods
During a cluster, randomised trial of the MET in 23 Australian hospitals, we collected
the data on lowest systolic blood pressure, highest and lowest respiratory rate and
heart rate from 15 min to 24 h before an adverse event (cardiac arrest, death or unexpected intensive care unit
admission) or emergency team call. We derived the document of these vital signs (yes/no)
from the numerical values recorded. We used analytically weighted and random-effect
regression models to examine the association between non-documented (missing) vital
signs, hospital characteristics and MET allocation, and to examine their trend over
time.
Results
We found marked variability in documentation, with a high proportion of missing vital
signs in some hospitals. Close to 77% of patients suffering adverse events had at
least one vital sign missing immediately before the event. Allocation to a MET system
was associated with significantly increased documentation of respiratory rate and
blood pressure before emergency team review (P < 0.01) as well as an improvement in documentation over time (P < 0.01). At all stages and for both MET and control hospitals, the respiratory rate
was the least commonly documented vital sign (P < 0.01).
Conclusions
The documentation of vital signs in the period before adverse events was commonly
incomplete with a particular deficiency in the documentation of the respiratory rate.
Introduction of a MET system was associated with improvement in the rate of documentation
of vital signs.
Keywords
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Article info
Publication history
Published online: November 17, 2008
Accepted:
October 5,
2008
Received in revised form:
August 21,
2008
Received:
May 14,
2008
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.10.009.
Identification
Copyright
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
