Flash mob research: a single-day, multicenter, resident-directed study of respiratory rate

Abstract

Background: Vital signs are critical data in the care of hospitalized patients, but the accuracy with which respiratory rates are recorded in this population remains uncertain. We used a novel flash mob research approach to evaluate the accuracy of recorded respiratory rates in inpatients.

Methods: This was a single-day, resident-led, prospective observational study of recorded vs directly observed vital signs in nonventilated patients not in the ICU on internal medicine teaching services at six large tertiary-care centers across the United States.

Results: Among the 368 inpatients included, the median respiratory rate was 16 breaths/min for the directly observed values and 18 breaths/min for the recorded values, with a median difference of 2 breaths/min (P < .001). Respiratory rates of 18 or 20 breaths/min accounted for 71.8% (95% CI, 67.1%-76.4%) of the recorded values compared with 13.0% (95% CI, 9.5%-16.5%) of the directly observed measurements. For individual patients, there was less agreement between the recorded and the directly observed respiratory rate compared with pulse rate.

Conclusions: Among hospitalized patients across the United States, recorded respiratory rates are higher than directly observed measurements and are significantly more likely to be 18 or 20 breaths/min.

Figure 1.

Directly observed vs recorded respiratory and pulse rates. Density plots of the frequency of specific respiratory rate and pulse rate values are shown among directly observed and recorded measurements.

Figure 2.

Bland-Altman plot of respiratory and pulse rates. Differences between directly observed and recorded values vs the mean of those measurements are shown. Each dot indicates a specific patient. Black dots indicate ≤ 2 h between measurement of directly observed and recorded values. Red dots indicate > 2 h between measurements.