Improving initial vital signs assessment and documentation in the emergency department of regional hospital, Bhutan: quality improvement project.

Abstract

Vital signs are key indicators of a patient's physiological status. It includes blood pressure, temperature, pulse rate, respiration rate and oxygen saturation (SPO₂). Derangements in vital signs are associated with an increased risk of morbidity and mortality, and thus serve as important indicators for risk stratification and early detection of clinical deterioration. Despite this, several studies have indicated that vital signs are not consistently recorded, which can have a significant impact on the effectiveness of the rapid response system. A baseline study in our emergency room showed that the rate of complete assessment and documentation is only 40%. A quality improvement initiative was undertaken to improve the initial vital signs assessment and documentation in the Emergency Department of a Regional Referral hospital for a duration of 10 weeks. Our team implemented four cycles of intervention which were based on a baseline survey, analysis of plan-do-study-act cycles, previous similar projects and discussion within the group. The interventions included sensitisation about the vital signs, making monitoring equipment easily available and redesigning areas for assessment and documentation. The rate of complete assessment and documentation of vital signs increased significantly from 40% to 97% at the end of the 10 week period.