Abstract
BackgroundVital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood.This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments.MethodsSemi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data.ResultsFactors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control.ConclusionsVital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0305-4) contains supplementary material, which is available to authorized users.
Highlights
Vital sign data are important for clinical decision making in emergency care
Factors affecting vital sign data quality The factors resulting from the content analysis are presented according to the main themes and categories that were found in our analysis (Table 2)
Care process A standardized process The interviews showed a perceived importance in following a predefined workflow to increase the quality of vital sign data measurement and documentation
Summary
Vital sign data are important for clinical decision making in emergency care. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Vital sign data are important in emergency care decision making, especially for prioritization and identification of severe illness. To screen for sepsis, vital signs are essential in early detection [1, 2], and it is well known that rapid detection and early treatment are key factors to improve patient survival [3]. The common denominator of most triage models is that they use vital sign measurements to calculate a triage score
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