Overnight vital signs traditionally are collected every four hours among hospitalized patients regardless of their risk of clinical deterioration, and these vital checks may have negative effects such as distress and sleep deprivation on low-risk patients, University of Chicago researchers wrote in a study published July 1 on the website of JAMA Internal Medicine.
The study included 54,096 patients at a 550-bed academic institution. The patients accounted for 182,828 patient-days and 1,699 adverse events between November 2008 and August 2011. Dana P. Edelson, MD, MS, and colleagues investigated whether the Modified Early Warning Score (MEWS) could identify low-risk patients who might forgo overnight vital sign monitoring.
The median evening MEWS was 2. The adverse event rate increased with higher evening MEWS. However, the frequency of vital sign disruptions was unchanged, with a median of two vital sign checks per patient per night and at least one disruption because of vital-sign collection on 99.3% of the nights regardless of MEWS category. Almost half (45%) of all nighttime vital-sign disruptions occurred in patients with a MEWS of 1 or less.
“The evening MEWS identified a low-risk subset of patients who had significantly fewer adverse events but had overnight vital signs taken at a similar rate as high-risk patients,” the authors wrote. “This suggests that the nighttime frequency of vital sign monitoring for low-risk medical inpatients might be reduced.”
Such a reduction could have “significant healthcare resource implications,” the authors wrote.
“With fewer vital sign collections required for most patients, overnight nurse staffing could be moderated. This would represent a significant cost savings, considering that nursing wages account for one-quarter to one-third of a hospital’s operating budget.
“A tailored approach also would enable a reallocation of resources away from the sleep-deprived, low-risk patients to more careful monitoring of high-risk patients.”