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Observational Study
. 2021 Jan:158:30-38.
doi: 10.1016/j.resuscitation.2020.11.014. Epub 2020 Nov 19.

Impact of the coronavirus pandemic on the patterns of vital signs recording and staff compliance with expected monitoring schedules on general wards

Ina Kostakis  1 , Gary B Smith  2 , David Prytherch  1 , Paul Meredith  3 , Connor Price  1 , Anoop Chauhan  4 ; Portsmouth Academic ConsortIum For Investigating COVID-19 (PACIFIC-19)
Affiliations
Observational Study

Impact of the coronavirus pandemic on the patterns of vital signs recording and staff compliance with expected monitoring schedules on general wards

Ina Kostakis et al. Resuscitation. 2021 Jan.

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) placed increased burdens on National Health Service hospitals and necessitated significant adjustments to their structures and processes. This research investigated if and how these changes affected the patterns of vital sign recording and staff compliance with expected monitoring schedules on general wards.

Methods: We compared the pattern of vital signs and early warning score (EWS) data collected from admissions to a single hospital during the initial phase of the COVID-19 pandemic with those in three control periods from 2018, 2019 and 2020. Main outcome measures were weekly and monthly hospital admissions; daily and hourly patterns of recorded vital signs and EWS values; time to next observation and; proportions of 'on time', 'late' and 'missed' vital signs observations sets.

Results: There were large falls in admissions at the beginning of the COVID-19 era. Admissions were older, more unwell on admission and throughout their stay, more often required supplementary oxygen, spent longer in hospital and had a higher in-hospital mortality compared to one or more of the control periods. More daily observation sets were performed during the COVID-19 era than in the control periods. However, there was no clear evidence that COVID-19 affected the pattern of vital signs collection across the 24-h period or the week.

Conclusions: The increased burdens of the COVID-19 pandemic, and the alterations in healthcare structures and processes necessary to respond to it, did not adversely affect the hospitals' ability to monitor patients under its care and to comply with expected monitoring schedules.

Keywords: Deterioration; Monitoring; Protocol; Rapid response system; Vital signs.

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Figures

Fig. 1
Fig. 1
Monthly hospital admission numbers (total and specialty) during the period 01/03/2018 to 30/04/2020.
Fig. 2
Fig. 2
Recorded vital signs sets, stratified by EWS value and collection hour and expressed as a proportion of the total number collected during the 24 h period.
Fig. 3
Fig. 3
Monthly proportions of vital signs sets for each EWS from 01/03/2018 to 30/04/2020.
Fig. 4
Fig. 4
Proportions of ‘on time’, ‘late’ and ‘missed’ observations, categorised by EWS value groups, in the four study periods. [‘late’ = overdue by more than 33% of the expected TTNO calculated and displayed by Vitalpac; ‘missed’ = overdue by more than 67% of the expected TTNO]. TTNO = Time to next observation.
See this image and copyright information in PMC

References

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