1. Title
Workload for monitoring of vital signs: More (monitoring) is less (work)?
2. Authors
Mori Jones1, Elaine Hardman1, Joanne Roche1, Chris Subbe2, Bernd Duller3
3. Institution
1
Ysbyty Gwynedd, Penrhosgarnedd, Bangor, UK
School of Medical Sciences, Bangor University, Bangor, UK
3
Philips Healthcare, Stuttgart, Germany
2
4. Introduction
Recording of vital signs is crucial for prevention of cardio-pulmonary arrests and
catastrophic deterioration of patients on general hospital wards. Vital sign recording
is time consuming and documentation requirements in modern hospitals have
significantly increased over recent years.
Work-flow optimized recording of vital signs might reduce the time requirements for
physiological surveillance.
The subjective impact on workload perception has not been studied.
5. Methods
The Ysbyty Gwynedd is a District General Hospital affiliated with Cardiff and
Bangor University. It serves a population of 220.000 in an area of outstanding natural
beauty in North Wales.
VITAL II is an interventional trial of an integrated monitoring system with automated
notification of deteriorating patients. The monitoring system was installed in spring
2014 on two general wards. Tryfan ward is an acute gastro-enterology ward with a
significant proportion of patients with liver failure. Moelwyn ward is an acute
respiratory ward with a level II unit for acute Non-Invasive Ventilation.
We asked nurses to comment on changes in workload generated by vital signs
recording after installation of an enhanced monitoring system (Philips Guardian
Solution) using a structured annonymised questionnaire with visual analogue scales.
6. Results
35 questionnaires were returned in the control phase and 34 questionnaires in the
intervention phase using electronic vital sign monitoring. Nurses were a mix of
registered nurses and auxillary nurses with vocational training.
Nurses reported significant reduction in workload after the installation (Fig 1).
Relative reduction in workload was 30% by installation of a workflow optimized
spot-check monitor (Fig 2), 27% by installation of automated cableless sensors and
29% by installation of an automated system of notification of deterioration.
Free text comments suggested that reduction of workload was particularly noticeable
during night shifts when staffing was reduced.
7. Discussion
Workload is an important barrier to implementation of comprehensive monitoring
systems. We were able to show that the Guardian System is perceived as a reduction
of workload. The 30% of perceived reduction in workload is larger than that
previously measured [1] and might in part by caused by a reduction of cognitive load
and stress by workflow optimization.
8. Conflicts of interest
The study was part of the VITAL II study, a clinical trial sponsored by Philips
Healthcare. CPS is PI of the VITAL II study, and has received speaker fees from
Philips. BD is a consultant for Philips.
9. References:
Bellomo R, Ackerman M, Bailey M, Beale R, Clancy G, Danesh V, Hvarfner A,
Jimenez E, Konrad D, Lecardo M, Pattee KS, Ritchie J, Sherman K, Tangkau P; Vital
Signs to Identify, Target, and Assess Level of Care Study (VITAL Care Study)
Investigators. A controlled trial of electronic automated advisory vital signs
monitoring in general hospital wards. Crit Care Med. 2012 Aug;40(8):2349-61.
Fig 1: Reduction of workload in comparison of control and implementation phase
Interval Plot [Mean +, Median x, 95% CI]
-10
-15
Workload [%]
-20
-25
-30
-35
-40
-45
Workload Monitors
Workload Cableless
Workload System
Fig 2: Spotcheck monitor with automated calculation of Early Warning Scores and
notification of the Rapid Response Team