• Helen Cahill, Aaron Jones, Robert Herkes, Kathy Cook, Anne Stirling, Tanya Halbert, Amanda Yates, Sean Lal, Alan Gardo, Roy Donnelly, David J Gattas, and Royal Prince Alfred Hospital Clinical Emergency Response System Steering Committee.
• Royal Prince Alfred Hospital, University of Sydney, Australia.
• BMJ Qual Saf. 2011 Sep 1; 20 (9): 791-6.

AbstractINTRODUCTION Local and national awareness of the need to improve the recognition and response to the clinical deterioration of hospital inpatients is high. The authors designed and implemented a programme to improve recognition of deteriorating patients in their hospital; a new observation chart for vital signs was one of the major elements. The aim of the study is to evaluate the impact of the new chart and associated education programme on the completeness of vital-sign recording in ward areas. METHODS The setting is a university-affiliated teaching hospital in Sydney, Australia. Three study periods, each lasting 14 days (preintervention, 2 weeks postintervention, 3 months postintervention), were carried out in three wards. The new observation chart was supported by an education programme. The primary outcome measures were the ascertainment rates of individual vital signs as a proportion of total observation sets. RESULTS Documentation of respiratory rate increased from 47.8% to 97.8% (p<0.001) and was sustained at 3 months postintervention (98.5%). Collection of a full set of vital signs also improved by a similar magnitude. Basic neurological observation for all patients was introduced in the new chart; the uptake of this was very good (93.1%). Ascertainment rates of blood pressure and oxygen saturation also increased by small but significant amounts from good baseline rates of 97% or higher. CONCLUSION The introduction of a new observation chart, and education regarding its use and importance, was associated with a major improvement in the recording of respiratory rate and other vital signs.

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