Abstract：
UNASSIGNED: The frequency at which patients should have their vital signs (e.g. blood pressure, pulse, oxygen saturation) measured on hospital wards is currently unknown. Current National Health Service monitoring protocols are based on expert opinion but supported by little empirical evidence. The challenge is finding the balance between insufficient monitoring (risking missing early signs of deterioration and delays in treatment) and over-observation of stable patients (wasting resources needed in other aspects of care).
UNASSIGNED: Provide an evidence-based approach to creating monitoring protocols based on a patient\'s risk of deterioration and link these to nursing workload and economic impact.
UNASSIGNED: Our study consisted of two parts: (1) an observational study of nursing staff to ascertain the time to perform vital sign observations; and (2) a retrospective study of historic data on patient admissions exploring the relationships between National Early Warning Score and risk of outcome over time. These were underpinned by opinions and experiences from stakeholders.
UNASSIGNED: Observational study: observed nursing staff on 16 randomly selected adult general wards at four acute National Health Service hospitals. Retrospective study: extracted, linked and analysed routinely collected data from two large National Health Service acute trusts; data from over 400,000 patient admissions and 9,000,000 vital sign observations.
UNASSIGNED: Observational study found a variety of practices, with two hospitals having registered nurses take the majority of vital sign observations and two favouring healthcare assistants or student nurses. However, whoever took the observations spent roughly the same length of time. The average was 5:01 minutes per observation over a \'round\', including time to locate and prepare the equipment and travel to the patient area. Retrospective study created survival models predicting the risk of outcomes over time since the patient was last observed. For low-risk patients, there was little difference in risk between 4 hours and 24 hours post observation.
UNASSIGNED: We explored several different scenarios with our stakeholders (clinicians and patients), based on how \'risk\' could be managed in different ways. Vital sign observations are often done more frequently than necessary from a bald assessment of the patient\'s risk, and we show that a maximum threshold of risk could theoretically be achieved with less resource. Existing resources could therefore be redeployed within a changed protocol to achieve better outcomes for some patients without compromising the safety of the rest. Our work supports the approach of the current monitoring protocol, whereby patients\' National Early Warning Score 2 guides observation frequency. Existing practice is to observe higher-risk patients more frequently and our findings have shown that this is objectively justified. It is worth noting that important nurse-patient interactions take place during vital sign monitoring and should not be eliminated under new monitoring processes. Our study contributes to the existing evidence on how vital sign observations should be scheduled. However, ultimately, it is for the relevant professionals to decide how our work should be used.
UNASSIGNED: This study is registered as ISRCTN10863045.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/03) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 6. See the NIHR Funding and Awards website for further award information.
Patient recovery in hospital is tracked by measuring heart rate, blood pressure and other ‘vital signs’ and converting them into a score. These are ‘observed’ regularly by nursing staff so that deterioration can be spotted early. However, taking observations can disturb patients, and taking them too often causes extra work for staff. More frequent monitoring is recommended for higher scores, but evidence is lacking. To work out how often patients should be monitored, we needed to know how likely it is for patients to become more unwell between observations. We analysed over 400,000 patient records from two hospitals to understand how scores change with time. We looked at three of the most serious risks for patients in hospital. These risks are dying, needing intensive care or having a cardiac arrest. We also looked at the risk that a patient’s condition would deteriorate significantly before their measurements were taken again. We identified early signs of deterioration and how changes in vital signs affected the risk of a patient’s condition becoming worse. From this we calculated a maximum risk of deterioration. We then calculated different monitoring schedules that keep individual patients below this risk level. Some of those would consume less staff time than current National Health Service guidelines suggest. We also watched staff record patients’ vital signs. We learnt it takes about 5 minutes to take these measurements from each patient. This information helped us calculate how costs would change if patients’ vital signs were taken more or less often. We found that patients with a low overall score could have their vital signs monitored less often without being in danger of serious harm. This frees up nursing time so that patients with a higher score can be monitored more often. Importantly, this can be achieved without employing more staff.
UNASSIGNED: Provide an evidence-based approach to creating monitoring protocols based on a patient\'s risk of deterioration and link these to nursing workload and economic impact.
UNASSIGNED: Our study consisted of two parts: (1) an observational study of nursing staff to ascertain the time to perform vital sign observations; and (2) a retrospective study of historic data on patient admissions exploring the relationships between National Early Warning Score and risk of outcome over time. These were underpinned by opinions and experiences from stakeholders.
UNASSIGNED: Observational study: observed nursing staff on 16 randomly selected adult general wards at four acute National Health Service hospitals. Retrospective study: extracted, linked and analysed routinely collected data from two large National Health Service acute trusts; data from over 400,000 patient admissions and 9,000,000 vital sign observations.
UNASSIGNED: Observational study found a variety of practices, with two hospitals having registered nurses take the majority of vital sign observations and two favouring healthcare assistants or student nurses. However, whoever took the observations spent roughly the same length of time. The average was 5:01 minutes per observation over a \'round\', including time to locate and prepare the equipment and travel to the patient area. Retrospective study created survival models predicting the risk of outcomes over time since the patient was last observed. For low-risk patients, there was little difference in risk between 4 hours and 24 hours post observation.
UNASSIGNED: We explored several different scenarios with our stakeholders (clinicians and patients), based on how \'risk\' could be managed in different ways. Vital sign observations are often done more frequently than necessary from a bald assessment of the patient\'s risk, and we show that a maximum threshold of risk could theoretically be achieved with less resource. Existing resources could therefore be redeployed within a changed protocol to achieve better outcomes for some patients without compromising the safety of the rest. Our work supports the approach of the current monitoring protocol, whereby patients\' National Early Warning Score 2 guides observation frequency. Existing practice is to observe higher-risk patients more frequently and our findings have shown that this is objectively justified. It is worth noting that important nurse-patient interactions take place during vital sign monitoring and should not be eliminated under new monitoring processes. Our study contributes to the existing evidence on how vital sign observations should be scheduled. However, ultimately, it is for the relevant professionals to decide how our work should be used.
UNASSIGNED: This study is registered as ISRCTN10863045.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/03) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 6. See the NIHR Funding and Awards website for further award information.
Patient recovery in hospital is tracked by measuring heart rate, blood pressure and other ‘vital signs’ and converting them into a score. These are ‘observed’ regularly by nursing staff so that deterioration can be spotted early. However, taking observations can disturb patients, and taking them too often causes extra work for staff. More frequent monitoring is recommended for higher scores, but evidence is lacking. To work out how often patients should be monitored, we needed to know how likely it is for patients to become more unwell between observations. We analysed over 400,000 patient records from two hospitals to understand how scores change with time. We looked at three of the most serious risks for patients in hospital. These risks are dying, needing intensive care or having a cardiac arrest. We also looked at the risk that a patient’s condition would deteriorate significantly before their measurements were taken again. We identified early signs of deterioration and how changes in vital signs affected the risk of a patient’s condition becoming worse. From this we calculated a maximum risk of deterioration. We then calculated different monitoring schedules that keep individual patients below this risk level. Some of those would consume less staff time than current National Health Service guidelines suggest. We also watched staff record patients’ vital signs. We learnt it takes about 5 minutes to take these measurements from each patient. This information helped us calculate how costs would change if patients’ vital signs were taken more or less often. We found that patients with a low overall score could have their vital signs monitored less often without being in danger of serious harm. This frees up nursing time so that patients with a higher score can be monitored more often. Importantly, this can be achieved without employing more staff.
摘要：
■患者出现生命体征的频率（例如，血压，脉搏,氧饱和度)在医院病房测量的目前未知。当前的国家卫生服务监测协议基于专家意见，但很少有经验证据支持。挑战是在监测不足（有可能错过恶化的早期迹象和治疗延误）和对稳定患者的过度观察（浪费其他方面的护理所需资源）之间找到平衡。
■提供一种基于证据的方法，根据患者病情恶化的风险制定监测方案，并将其与护理工作量和经济影响联系起来。
我们的研究包括两部分：（1）对护理人员进行观察研究，以确定进行生命体征观察的时间；（2）对患者入院历史数据进行回顾性研究，探讨国家早期预警评分与随时间变化的结果风险之间的关系。这些得到了利益相关者的意见和经验的支持。
■观察性研究：观察了在四个急性国家卫生服务医院的16个随机选择的成人普通病房的护理人员。回顾性研究：提取，链接并分析了来自两个大型国家卫生服务急性信托的常规数据；来自超过400,000名患者入院和9,000,000个生命体征观察的数据。
■观察性研究发现了多种做法，两家拥有注册护士的医院接受了大部分的生命体征观察，以及两名青睐的医疗保健助理或学生护士。然而,观察的人花费的时间大致相同。在“回合”中，平均每次观察时间为5:01分钟，包括定位和准备设备以及前往患者区域的时间。回顾性研究创建了生存模型，预测自上次观察患者以来随时间变化的预后风险。对于低风险患者，观察后4小时和24小时的风险差异不大.
■我们与我们的利益相关者（临床医生和患者）探讨了几种不同的情况，基于如何以不同的方式管理“风险”。生命体征观察通常比对患者风险的秃头评估更频繁，我们表明，理论上可以用更少的资源实现最大风险阈值。因此，可以在更改后的协议中重新部署现有资源，以在不影响其余患者安全性的情况下为某些患者实现更好的结果。我们的工作支持当前监测协议的方法，患者国家早期预警评分2指导观察频率。现有的做法是更频繁地观察高风险患者，我们的发现表明这是客观合理的。值得注意的是，重要的护患互动发生在生命体征监测期间，不应在新的监测过程中消除。我们的研究为如何安排生命体征观察的现有证据做出了贡献。然而,最终,由相关专业人员决定如何使用我们的工作。
■本研究注册为ISRCTN10863045。
■该奖项由国家健康与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：17/05/03）资助，并在《健康与社会护理提供研究》中全文发表。12号6.有关更多奖项信息，请参阅NIHR资助和奖励网站。
通过测量心率来跟踪患者在医院的康复情况，血压和其他“生命体征”，并将其转换为分数。护理人员会定期“观察”这些情况，以便及早发现恶化。然而,观察会打扰病人，太频繁地服用它们会给员工带来额外的工作。更频繁的监测建议更高的分数，但是缺乏证据。为了计算出应该多久监测一次患者，我们需要知道患者在两次观察之间变得更加不适的可能性。我们分析了两家医院的40多万份患者记录，以了解分数如何随时间变化。我们研究了住院患者面临的三个最严重的风险。这些风险正在消亡，需要重症监护或心脏骤停.我们还研究了患者病情在再次进行测量之前会明显恶化的风险。我们确定了恶化的早期迹象以及生命体征的变化如何影响患者病情恶化的风险。由此，我们计算出恶化的最大风险。然后，我们计算了不同的监测时间表，使个体患者保持在此风险水平以下。其中一些消耗的员工时间比当前的国家卫生服务指南所建议的要少。我们还观察了工作人员记录患者的生命体征。我们了解到从每个患者那里进行这些测量大约需要5分钟。这些信息帮助我们计算出，如果患者的生命体征被或多或少地采取，成本将如何变化。我们发现，总体评分较低的患者可以较少监测其生命体征，而不会有严重伤害的危险。这释放了护理时间,从而可以更频繁地监测具有较高评分的患者。重要的是,这可以在不雇用更多工作人员的情况下实现。
■提供一种基于证据的方法，根据患者病情恶化的风险制定监测方案，并将其与护理工作量和经济影响联系起来。
我们的研究包括两部分：（1）对护理人员进行观察研究，以确定进行生命体征观察的时间；（2）对患者入院历史数据进行回顾性研究，探讨国家早期预警评分与随时间变化的结果风险之间的关系。这些得到了利益相关者的意见和经验的支持。
■观察性研究：观察了在四个急性国家卫生服务医院的16个随机选择的成人普通病房的护理人员。回顾性研究：提取，链接并分析了来自两个大型国家卫生服务急性信托的常规数据；来自超过400,000名患者入院和9,000,000个生命体征观察的数据。
■观察性研究发现了多种做法，两家拥有注册护士的医院接受了大部分的生命体征观察，以及两名青睐的医疗保健助理或学生护士。然而,观察的人花费的时间大致相同。在“回合”中，平均每次观察时间为5:01分钟，包括定位和准备设备以及前往患者区域的时间。回顾性研究创建了生存模型，预测自上次观察患者以来随时间变化的预后风险。对于低风险患者，观察后4小时和24小时的风险差异不大.
■我们与我们的利益相关者（临床医生和患者）探讨了几种不同的情况，基于如何以不同的方式管理“风险”。生命体征观察通常比对患者风险的秃头评估更频繁，我们表明，理论上可以用更少的资源实现最大风险阈值。因此，可以在更改后的协议中重新部署现有资源，以在不影响其余患者安全性的情况下为某些患者实现更好的结果。我们的工作支持当前监测协议的方法，患者国家早期预警评分2指导观察频率。现有的做法是更频繁地观察高风险患者，我们的发现表明这是客观合理的。值得注意的是，重要的护患互动发生在生命体征监测期间，不应在新的监测过程中消除。我们的研究为如何安排生命体征观察的现有证据做出了贡献。然而,最终,由相关专业人员决定如何使用我们的工作。
■本研究注册为ISRCTN10863045。
■该奖项由国家健康与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：17/05/03）资助，并在《健康与社会护理提供研究》中全文发表。12号6.有关更多奖项信息，请参阅NIHR资助和奖励网站。
通过测量心率来跟踪患者在医院的康复情况，血压和其他“生命体征”，并将其转换为分数。护理人员会定期“观察”这些情况，以便及早发现恶化。然而,观察会打扰病人，太频繁地服用它们会给员工带来额外的工作。更频繁的监测建议更高的分数，但是缺乏证据。为了计算出应该多久监测一次患者，我们需要知道患者在两次观察之间变得更加不适的可能性。我们分析了两家医院的40多万份患者记录，以了解分数如何随时间变化。我们研究了住院患者面临的三个最严重的风险。这些风险正在消亡，需要重症监护或心脏骤停.我们还研究了患者病情在再次进行测量之前会明显恶化的风险。我们确定了恶化的早期迹象以及生命体征的变化如何影响患者病情恶化的风险。由此，我们计算出恶化的最大风险。然后，我们计算了不同的监测时间表，使个体患者保持在此风险水平以下。其中一些消耗的员工时间比当前的国家卫生服务指南所建议的要少。我们还观察了工作人员记录患者的生命体征。我们了解到从每个患者那里进行这些测量大约需要5分钟。这些信息帮助我们计算出，如果患者的生命体征被或多或少地采取，成本将如何变化。我们发现，总体评分较低的患者可以较少监测其生命体征，而不会有严重伤害的危险。这释放了护理时间,从而可以更频繁地监测具有较高评分的患者。重要的是,这可以在不雇用更多工作人员的情况下实现。
