Frequency of vital sign assessment and clinical deterioration in an Australian emergency department

Lambe, Katherine; Currey, Judy; Considine, Julie

doi:10.1016/j.aenj.2016.09.001

Cited by 19 publications

(20 citation statements)

References 39 publications

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“…| 1011 physiological instability and underpins escalation of care decisions . Within the ED, derangements in vital signs occur in 9.5%-14.5% of patients (Considine, Rawet, & Currey, 2015;Lambe, Currey, & Considine, 2016). Vital sign derangements during a patient's ED stay can have significant implications following admission to hospital wards given their association with adverse events such as unplanned intensive care admissions, in-hospital mortality and rapid response team (RRT) activations (Considine, Charlesworth, & Currey, 2014;Considine et al, 2016a;Farley et al, 2010;Jones, Yiannibas, Johnson, & Kline, 2006;Kennedy, Joyce, Howell, Lawrence Mottley, & Shapiro, 2010;Mora et al, 2015;Walston et al, 2016).…”

Section: Cross Et Almentioning

confidence: 99%

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Nursing handover of vital signs at the transition of care from the emergency department to the inpatient ward: An integrative review

Cross

Considine

Currey

2018

Journal of Clinical Nursing

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Section: Cross Et Almentioning

confidence: 99%

“…Within the ED, derangements in vital signs occur in 9.5%-14.5% of patients (Considine, Rawet, & Currey, 2015;Lambe, Currey, & Considine, 2016). Current processes and focused content for transferring accountability of nursing care from nurses in ED to the ward setting remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Nursing handover of vital signs at the transition of care from the emergency department to the inpatient ward: An integrative review

Cross

Considine

Currey

2018

Journal of Clinical Nursing

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“…In 2019, the New South Wales (NSW) Clinical Excellence Commission reported a 29% increase in hospital adverse events (AEs) with poor observations and monitoring as a causal factor (7). Undetected clinical deterioration in Australian emergency departments occurs in up to one in seven patients causing highmortality adverse events (8)(9)(10)(11). Recognising and responding to deteriorating emergency department patients in a timely manner is primarily an emergency nursing responsibility (12).…”

Section: Introductionmentioning

confidence: 99%

Does the Implementation of an Emergency Nursing Framework (HIRAID) Reduce patient Deterioration? A Multi-Centre Quasi-Experimental Study

Curtis

Munroe

Fry

et al. 2020

Preprint

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Background: Recognition and response of deteriorating patients is fundamental to safe, high quality healthcare. Failure to recognise and respond to deteriorating patients is associated with serious adverse events, both during and after emergency department care. This study aims to determine if the implementation of HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment), an emergency nursing framework, improves patient safety.Methods: This quasi-experimental cohort study was conducted between November 2017 and February 2019 in two regional hospitals in [Anonymised], Australia. HIRAID was implemented using a multi-pronged behaviour change intervention. Data of 920 patients (374 pre-cohort and 546 post-cohort) who had an episode of deterioration within 72 hours of emergency department departure were collected. Statistical tests were conducted as two-sided, with a 95% confidence interval to determine pre/post cohort association. The StaRI checklist was used in reporting this study.Results: Patients in the post group were older with more comorbidities, but experienced fewer episodes of clinical deterioration associated with care delivered in the emergency department (27% to 13%). There was a reduction in treatment delays [pre n=28 (28.3%) versus post n=11 (15.1%), p=0.041, 95% CI (1.1%–25.3%)], and delay or failure to escalate care when abnormal vital signs were identified [pre n=20 (20.2%) versus post n=5 (6.9%), p=0.014, 95% CI (3.5%–23.1%)]. The proportion of isolated nursing-related causal factors decreased from 20 (21%) to 6 (8%). Conclusions: HIRAID is a standardised emergency nursing framework which provides a structured, evidence-based approach to emergency nursing assessment that could be adapted for a variety of clinical settings. Implementing HIRAID using the principles of behavior change is associated with a reduction in clinical deterioration related to emergency care.

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“…18 Portanto, pesquisas reforçam a importância da vigilância rigorosa do conjunto de parâmetros fisiológicos em uma unidade de emergência. 6,15,[18][19] Por fim, a realização da coleta de dados em uma única instituição por meio da análise retrospectiva de prontuários é uma limitação do estudo e tal fato deve ser considerado na generalização dos resultados.…”

Section: Introdução Introdução Introdução Introduçãounclassified

“…Outro destaque desta pesquisa foi a baixa frequência das anotações de conduta frente às alterações dos sinais vitais, sendo que os registros de suporte ventilatório e administração de medicamento, medidas fundamentais para permeabilidade da via área e manutenção da circulação, foram os mais encontrados. Os achados dos resultados desta investigação buscam refletir o papel da enfermagem no reconhecimento de alterações dos sinais vitais e o registro adequado, visto que é a profissão que mais passa tempo com o paciente 6,15. As omissões dos registros das alterações dos sinais vitais associadas a longas horas de trabalho e, por vezes, o número insuficiente de profissionais da enfermagem podem comprometer a qualidade da assistência e a ocorrência de evento adverso, mesmo não tendo nenhuma evidência que comprove que as longas jornadas de trabalho da enfermagem sejam capazes de trazer menos segurança para o paciente [20][21].…”

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Alteração de sinais vitais e desfecho clínico de pacientes admitidos em unidade de emergência

Oliveira

Reis

Cruz³

et al. 2020

Rev Enferm UFSM

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Objetivo: descrever as características dos registros de enfermagem, incluindo os sinais vitais, e comparar o desfecho clínico dos pacientes segundo a presença de alteração dos sinais vitais no ambiente de emergência. Método: estudo transversal, com análise retrospectiva de prontuários de pacientes adultos admitidos em maio/2018 em um Pronto-Socorro de São Paulo. Os dados dos registros de enfermagem coletados foram inseridos no sistema REDCap® e análises descritivas e inferenciais foram realizadas. Resultados: dos 194 prontuários (54,1% masculino, idade média 59,7 anos) a queixa de entrada, comorbidades e primeiras condutas realizadas na emergência foram os registros de enfermagem mais anotados. Frequências cardíaca e respiratória e pressão arterial foram os sinais vitais mais alterados e associados ao óbito. Conclusão: a clareza e a frequência dos registros de enfermagem, assim como a correta interpretação dos sinais vitais, são componentes essenciais para a segurança do cuidado prestado ao paciente na emergência.

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Frequency of vital sign assessment and clinical deterioration in an Australian emergency department

Cited by 19 publications

References 39 publications

Nursing handover of vital signs at the transition of care from the emergency department to the inpatient ward: An integrative review

Nursing handover of vital signs at the transition of care from the emergency department to the inpatient ward: An integrative review

Does the Implementation of an Emergency Nursing Framework (HIRAID) Reduce patient Deterioration? A Multi-Centre Quasi-Experimental Study

Alteração de sinais vitais e desfecho clínico de pacientes admitidos em unidade de emergência

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