Vital signs assessment in hospitals

Vital signs or vitals indicate the condition of the life-sustaining functions in the body. At hospitals, vitals are used for assessing the patient’s current health status, and for monitoring the recovery or treatment process. This article presents various vital signs classifications, challenges in inpatient vitals monitoring, and solutions for effective vital sign assessment. The solutions are based on digital technology, especially with the use of connected diagnostic devices and electronic health records (EHRs).

In this blog you will learn:

• What types of vital signs are there?
• What are the challenges of vital signs assessment in hospitals?
• How to effectively perform vital sign assessments in hospitals?

What types of vital signs are there?

Vital sign classifications depend on the healthcare system and clinical settings.

In the classification that uses 4 main vital signs, these are: body temperature, blood pressure, pulse (heart rate), and respiratory rate (breathing rate), with different reference values for paediatric, adult and elderly patients. (For example, children have higher pulse than adults, and the elderly have a lower core body temperature.) [1] [2] [3] [4]

The fifth vital sign is usually oxygen saturation, which has come into prominence during the COVID-19 pandemic [5]. Other fifth vital signs include pain, blood glucose level, and even menstrual cycle [6], [7] [8] [9] [10]. The sixth vital sign is speciality-dependent and may be end-tidal CO2 (in trauma patients), dyspnea (generally in patients with chronic obstructive pulmonary disease), gait speed (in the elderly), functional status, or delirium [11] [12] [13] [14] [15] [16].

With the exceptions of pain (which is self-reported and therefore subjective) and the level of consciousness (depending on the setting and specificity, it can be assessed with the Glasgow Coma Scale, ACVPU, FOUR, etc.), the aforementioned vital signs can be measured with various methods and diagnostic devices [3] [4].

What are the challenges of vital signs monitoring in hospitals?

Administrative burden

Extensive administrative tasks are a growing issue in modern healthcare worldwide and one of the leading causes of burnout [9] [10] [11] [12] [13] [14]. Vital signs consist of numerous parameters; without optimum digital technology, the measurement process consists of many steps on different devices, followed by the manual entering of the results into the patient’s file and/or chart.

Studies show that nurses and paramedics at the highest risk of burnout [15]. Nurses are often delegated the majority of the administrative tasks, which results in less time for patients [14]. There is a correlation between nurse burnout and nurse rating of the safety culture and care quality at the hospital [16] [17] [18]. This is worrisome as nurses are not only tasked with the monitoring of vital signs, but also with the recognition of their trends and timely detection of any deterioration [19].

Medical procedure errors

The deterioration trends in vital signs reflect in failure‐to‐rescue (FTR) rates – the number of unprevented deaths of patients who developed complications connected with medical care, underlying conditions or surgery [20].

Despite the well-researched correlation between the deterioration of some vital signs hours before major medical events such as cardiopulmonary arrest, medical professionals can have insufficient knowledge on the importance of vital sign changes and how they impact patient care [21] [22] [23] [24]. For this reason, vital sign changes can go unnoticed or are detected when it is too late to act [25] [26] [27] [28]. The reasons for that are various, e.g. inadequate measurement, inappropriate response to abnormal values, or unclear policies on how often vital signs should be measured [5] [29] [30] [31].

Errors due to manual data entry

Hospital nurses often write down vital signs manually and later transcribe them into the patient’s health record. Not only does this process cause errors, but takes a significant amount of time. The average time required for measuring vital signs and recording them by hand may be more than 5 minutes [32] [33]. Using EHRs is significantly faster and can cut the time spent by half [34] [35].

A study compared timeliness and data accuracy between three different management protocols for vita signs data [36]: a paper-based one (writing down the data from a vital signs monitor on a piece of paper and then transcribing it into a paper medical record); a combination of paper and electronic data entry (transcribing from handwritten notes into an EHR system on a PC on a portable, wheeled workstation); and EHR data entry using a tablet fixed next to the vital signs monitor [36]. The third protocol was significantly faster than the other two although it would have probably been even faster if the data transfer between the diagnostic device and the tablet was more seamless.

Insufficient EHR implementation and connectivity

EHRs have many benefits compared to paper records. The most important advantage is improved quality of care, for many reasons: higher efficiency, fewer medical errors due to greater data reliability, and improved data accessibility for clinicians and medical researchers [37] [38] [39] [40]. Furthermore, the costs are lower and there are fewer malpractice claims against EHR users than against users of paper medical records. [41]

An important point to consider with extensive use of EHRs is data security issues [42] [43] [44]. Among many other things, these issues are connected with staff training. Training plays a central role in the success and security of EHR implementation. If the staff is not appropriately trained, this increases their dissatisfaction with the EHR system and can result in serious medical errors [45] [46]. Another decisive factor in EHR implementation is the sensitivity of the work environment to staff needs – promotion of nurse autonomy, adequate nurse staffing, involvement in administrative decisions, teamwork, flexible workflow, etc. [47] [48] [49] [50] [51] Lastly, the EHR system must be intuitive and easy to use, also in terms of vital signs measurement and entry of the data obtained in the process. [52]

How to effectively perform vital sign assessments in hospitals?

Digital vital signs measurement

The MESI mTABLET Vitals is an all-in-one solution for monitoring vital signs. It automates measurements of blood pressure, oxygen saturation, and temperature (offering a contactless and a contact thermometer in one), while allowing manual input for respiratory rate, pain and ACVPU. The manual input is slide-based for saving time. It also offers automated NEWS2 S1 Early Warning Score, which helps detects patient deterioration early and provides alerts based on standardised criteria.

Upon confirmation, the vitals measurement result is automatically saved into the digital patient file; it can be accessed at any point and compared to the previous measurements in graph form. Its seamless integration with your EHR reduces administrative tasks and errors.

All the diagnostic tools are wireless, which not only improves mobility and hygiene but also save space and makes workflows more efficient.

Beyond vitals management, the MESI mTABLET Vitals is part of a larger MESI mTABLET diagnostic system. This means that you can always add other diagnostic tools (ECG, advanced spirometry, Ankle-Brachial Index, etc.) as well as clinical apps for wound management and protocol creation. The system is scalable, which makes it adaptable for various departments, and contributes to long-term cost saving in comparison to individual separate devices. This makes it a flexible, intelligent solution for modern hospital environments.