Vital Signs: From Monitoring to Prevention of Deterioration in General Wards

Abstract

Vital sign measurement is at the core of our care for hospitalized patients. Together with other observations, such as seizures, airway obstruction or a decrease in the level of consciousness, changes in vital signs can describe patients who are at serious risk of deterioration [1]. They form the basis of the criteria for medical emergency teams (METs) or, as they are also known, rapid response systems [1]. Sudden or gradual changes in vital signs can indicate life-threatening clinical states requiring urgent intervention and sometimes triage to a higher level of care. Interestingly, patients in an intensive care environment rarely die or have a cardiac arrest unexpectedly. The majority of deaths are as a result of withdrawing and/or withholding active management [2]. The reason is simple: Patients in intensive care are continuously monitored and are under the care of well-trained staff. Rapid response systems can now provide an urgent response by appropriately trained staff outside the intensive care unit (ICU) setting. However, general ward staff must be able to identify patients who are at-risk and, when appropriate, escalate care [3]. This is difficult when patients on general wards are monitored intermittently in much the same way they have been for over a century. Much can happen to a patient’s clinical state in the hours between vital sign recordings, often taken at 8 to 24-hour intervals. Unfortunately this low frequency of observations has little or no evidence base and may be inappropriate, especially for the current hospital population, which is older, more vulnerable as a result of chronic illness, and is having more complex procedures with higher rates of complications. The frequency of vital sign observations has been based on tradition, [4] and usually is not changed unless obvious deterioration is detected or higher frequency is recommended by doctors [5].