1 May 2021
The key to improving patient outcomes lies in monitoring, and rapid recognition of any changes to enable a clinically informed decision. The Royal College of Physicians developed a National Early Warning Score (NEWS2) to drive improvement in patient outcomes and to help to respond to clinical deterioration in patients.
NEWS2 is based on six physiological parameters which form the basis of a scoring system, as follows:
A score is assigned to each parameter as they are monitored, with the total score giving a reflection on how the parameters vary from a ‘normal’ range. This then determines what actions are needed by caregivers to support escalation if required. NHS England described how this standardised approach can reduce the number of patients whose conditions deteriorate whilst in hospital, potentially saving over 1800 lives a year. Standardising the NEWS2 tool across the NHS would allow for improved early detection of deterioration in patients, and thus far 70% of acute Trusts in England areusing NEWS2.
However, even though NEWS2 is being recommended to become the standard way in which vital signs are being monitored across the NHS, there are variations in the paper-based documentation of patient observations in NHS Trusts country-wide. Despite their prominence in clinical practice, how to best monitor and interpret a patient’s vital signs is often up for discussion and debate. The discrepancies in how observations are documented can be due to many variables across NHS Trusts. Issues such as staffing levels and limited treatment time are factors when it comes to the ongoing monitoring of patients. Current guidelines recommend that patient observations are conducted every 12 hours as a minimum frequency. However, it is also widely acknowledged that this ‘12-hour wait’ could be too long a period to effectively detect and manage patient deterioration. Inter-observer variability also impacts readings – successfully making note of an observation requires the close attention of the healthcare professional to the patient, however, in reality this can be a challenge. Disruptions by the surrounding setting such as patient/family discussions and environmental interruptions can make taking an accurate reading & transcribing difficult.
Imperial College Healthcare NHS Trust (ICH) noted these variables and decided to develop a study into whether automating this system would make important patient information more accessible, support staff in rapid decision making, highlight trends and help clarify clinical judgements on risk and escalation. The Trust invested in Hillrom’s Welch Allyn Connex vital signs devices to help
achieve these objectives. It was hypothesised that the use of a connected vital signs monitor, instead of manually noting patient observations on paper, would decrease caregiver time required to monitor and document a patients’ vitals while also helping to eliminate the chance for transcription errors. The study evaluated the time it took for caregivers to take patient vitals with the Connex monitor wirelessly connected to a electronic medical record (EMR), compared to the time it took to take vitals manually.
The study found that ICH recorded significant time savings for caregivers when using the Welch Allyn Connex vital signs device compared to recording observation manually on paper. The mean time to take and record vitals using the Connex vital signs device was 1 minute 12 seconds, comparatively it took 2 minutes 35 seconds when recording manually. This was a difference of 83 seconds per patient, equivalent to a time saving of 53.5% to conduct a full set of NEWS2 observations.
By using a connected vital signs devices, around 600 hours of nursing time was released in a year? that would usually be spent on routine documentation and admin, allowing time to be channelled directly into patient care. The automation of the process also allows for greater confidence in the accuracy of the data entered into the EMR. This adds up to an estimated saving of 30 hours per month of audit time. All together this is projected as 323,500 hours a year across the ICH Trust.
As a result, vitals could be all documented without delay, streamlining workflow for the caregiver, improving efficiency and enhancing patient safety. As a direct result of this study, the digital system and process, was rolled out across the entire Trust. John Groetelaars, president and CEO, Hillrom adds; “With staffing pressures in the NHS, supporting clinicians to measure a complete set of observations within a single monitoring device could potentially save lives by quickly identifying deterioration in a patient in a cost-efficient and timely manner. By using connected technology platforms, such as the Hillrom Welch Allyn Connex Spot Monitor, patient assessments can be standardised with information directly channelled into the Electronic Patient Record, reducing the chance for transcription error. This, in turn, improves patient safety through earlier detection of patient deterioration and a real-time individual NEWS2 score whilst also providing caregivers with escalation instructions at the bedside appearing automatically on screen from the bedside. If both the NEWS2 score and the connected device platform for monitoring patient’s vital signs were fully standardised across the NHS there is the potential for the early detection of patient deterioration to be improved. Updating current care facilities to a connected platform offers a digital transformation that has capacity to extensively monitor patient deterioration and drive much-needed efficiencies across the NHS reducing caregiver time and improving patient outcomes. By using and successfully implementing connected technology platforms with a standardised NEWS2 system the NHS could meet its plan to have all acute care facilities fully digitised by 2024.”
With staffing pressures in the NHS, supporting clinicians to measure a complete set of observations within a single monitoring device could potentially save lives by quickly identifying deterioration in a patient in a cost-efficient and timely manner.
John Groetelaars, President and CEO - Hillrom