How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study

Abstract

IntroductionMonitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered.ObjectiveTo estimate the time taken to measure and record one set of patient’s vital signs observations; and to identify factors associated with time to measure and record one set of patient’s vital signs observations.MethodsWe undertook a time-and-motion study of 16 acute medical or surgical wards across four hospitals in England. One hospital recorded vital signs on paper, while three recorded measurements on electronic devices. Two trained observers followed a standard operating procedure to record the time taken to measure and record vital sign observations. We used mixed-effects models to estimate the mean time using whole observation rounds, which included preparation time, or time spent taking observations at the bedside. We tested whether our estimates were influenced by nurse, ward and hospital factors.ResultsAfter excluding non-vital signs related interruptions, dividing the length of an observation round by the number of observations in that round yielded an estimated time per observation set of 5 minutes and 1 second (95% Confidence Interval (CI) = 4:39-5:24). If interruptions within the round were included, the estimated time was 6:26 (95% CI = 6:01-6:50). If only time taking each patient’s observations at the bedside was considered, after excluding non-vital signs related interruptions the estimated time was 3:45 (95% CI = 3:32-3:58). We found no substantial differences by hospital, ward or nurse characteristics, despite different systems for recording observations being used across the hospitals.DiscussionThe time taken to observe and record a patient’s vital signs is considerable, so changes to recommended observation frequency could have major workload implications. Variation in estimates derived from previous studies may, in part, arise from a lack of clarity about what was included in the reported times. We found no evidence that nurses save time when using electronic vital signs recording, or that the grade of staff taking the observation influenced the time taken.ConclusionsTaking and recording vital signs observations is time consuming and the impact of interruptions and preparation away from the bedside is considerable. When considering the nursing workload around vital signs observations, no assumption of relative efficiency should be made if different technologies or staff groups are deployed.

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

“…This is the first study of its kind that reports the workload involved across the entire spectrum of RRS activities as the previously reported studies have only measured the workload involved in the efferent limb of the RRS – measuring and recording vital signs and EWS [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Therefore, our study offers to extend the body of knowledge particularly by adding the quantification of workload involved in responding to deteriorating patients by a rapid response team or critical care outreach team.…”

“…Dall’Ora et al. [ 11 ] conducted a time-and-motion study in four hospitals in the United Kingdom (UK) using a comparable set of vital signs and found that average estimated time to measure and record a set of vital signs and EWS was 3.75 (95% CI = 3.53–3.97) minutes. They found no substantial differences by hospital, ward, or nurse characteristics, despite different systems for recording observations being used across the four hospitals.…”

Emergency department management of severely injured children in New South Wales

“…29 The lack of documentation of vital signs could be to the result of monitoring occurring not being documented due to the known time constraints in the resuscitation context, it takes at least 5 min to perform and record a set of vital signs uninterrupted. 30 Review of paediatric trauma cases previously recommended 1:1 nurse-patient ratios for paediatric trauma patients in the resuscitation area. 7 A solution would be automated downloading of vital signs from the monitoring systems to the electronic medical record in ED, similar to processes used in ICUs around Australia.…”

Introducing Lightweight IT – A Way to Build Flexibility for Healthcare Organizations?

“…To address this knowledge gap, the paper uses a socio-technical perspective to investigate the implementation of a lightweight IT application. Previous research has shown how technology and devices can support clinical workflow, reduce clinicians time spend on transferring information, and reduce error in clinical documentation [3,4] This paper has a broader focus and investigate how lightweight technology can be a means for more rapid organizational changes in line with healthcare professionals' needs and emerging requirements. Our research question is therefore: How can lightweight IT support rapid organizational changes?…”