Waking Hospital Patients to Check Vital Signs May Do More Harm Than Good
Study suggests nearly half might benefit more from undisturbed sleep
Monday, July 1, 2013
Nearly half the patients awakened for late-night vital-sign checks are extremely unlikely to suffer a medical emergency in the next 24 hours, said study author Dr. Dana Edelson, a hospitalist with the department of medicine at the University of Chicago.
If left alone and allowed to sleep, these patients likely will heal faster and have a better attitude during their hospital stay, she said.
Hospitals have been checking patients' vital signs every four hours dating back to 1893, Edelson said. Blood pressure, breathing rate, pulse and temperature are among the vital signs often evaluated.
These checks often disturb patients' sleep, which can cause considerable frustration for patients and deprive them of rest they need for healing.
"Everybody is reflexively getting woken up twice a night for vital signs, regardless of how high-risk they are," Edelson said.
Edelson reviewed data on more than 54,000 hospital patients using an early-warning score that normally judges which people need additional care because they are likely to suffer cardiac arrest or need intensive care.
But she flipped the early warning score on its head, looking instead for patients who are at such low risk that they don't need close scrutiny.
About 45 percent of hospital patients regularly wakened for vital-sign checks belong to the very lowest risk category, Edelson found in the study, which was published online July 1 in the journal JAMA Internal Medicine.
"Given what we know about sleep disruptions and how detrimental they are to actual clinical outcomes, we would hypothesize that decreased sleep interruptions in this low-risk patient population would improve outcomes," Edelson said.
Hospitals should consider using early-warning scores to determine which patients would benefit from fewer vital-sign checks, she said.
"It definitely would require a cultural change, there's no question about that," Edelson said. "We're practicing routine vital-sign collection in the same way Florence Nightingale did. Very little has changed. But we have much more data available to us now than before, and using that data to figure out how to best allocate our resources makes a lot of sense to me."
The study did have some limitations, the authors noted. For one, the findings came from a single hospital. Also, during vital-sign checks, nurses may pick up other more nuanced signs of a patient's health status.
Nancy Foster, the American Hospital Association's vice president for quality and patient safety policy, called Edelson's study "an interesting and very important piece of work."
"It represents data-driven answers to questions about what services that we've traditionally provided that could be changed to present more benefit to the patient," she said.
Letting low-risk patients get their sleep also would free up nursing time that would be better spent elsewhere, Foster added.
"They could be focusing attention on patients who are critically ill or in crisis," she said. "They could be double-checking medications or orders to make sure no mistakes are being made. It would be incredibly valuable to ensure that the nurses' time is well spent on services that are needed by patients."
It would be "challenging but not impossible" to shift hospital practices to reflect this new understanding of the importance of vital-sign checks, Foster said.
Hospital officials would need to make sure that staff saw the data and understood the benefits of such a change. Doctors and nurses then would have to make sure to explain the change in procedure clearly to patients.
"You don't want [patients] to think you're neglecting them now," Foster said. "You want them to know that you are making a change in your practice and you want them to be able to sleep better."