[Observation of critically ill patients].

INTRODUCTION: The aim of this study was to estimate to which extent patients with abnormal vital signs on general wards had their vital signs monitored and documented and to establish if staff concern for patients influenced the level of monitoring and was predictive of increased mortality. MATERIAL AND METHODS: Prospective observational study at Herlev Hospital, Copenhagen, Denmark. Study personnel measured vital signs on all patients present on five wards during the evening and night and interviewed nursing staff about patients with abnormal vital signs. Subsequently, patient records were studied. RESULTS: A total of 155 patients with abnormal vital signs were identified, and staff was interviewed about 139 patients. In 61 of these 139 patients, some vital signs were measured by staff, but the respiratory rate was not measured. In 86 cases staff decided to intervene because of abnormal vital signs measured by study personnel. A total of 77% of patients had vital signs documented in their records on the day of the observation. The previous day, vital signs were documented in 70% of records and on the day after in 66%. The documentation of vital signs was significantly higher when staff expressed concern for a patient in the patient record (95% vs. 65%, chi(2): p < 0.001), but 30-day mortality did not differ significantly (15% vs. 10%, chi(2): p = 0.40). CONCLUSION: In more than half of the patients, the abnormal vital signs were not identified by staff because the vital signs were not measured. In two out of three patients, staff decided to intervene because of abnormal vital signs measured by study personnel, indicating a need to reevaluate monitoring routines at general wards.