New patient chart to save 6,000 lives a year in the UK
Two Royal Medical Colleges introduce a new way to record patients' vital signs
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Friday 27 July 2012
For more than a century doctors have been recording patients' "vital signs" – temperature, blood pressure, heart rate – on the chart at the foot of the hospital bed, and then failing to act on what they found.
Yesterday, two UK Royal Medical Colleges became the first in the world to introduce a new way of displaying the measurements to compel action which is expected to halve avoidable deaths in hospital, saving at least 6,000 lives a year in the UK.
The simple innovation was described yesterday as a "step change" in patient safety. As well as saving lives it is expected to shorten hospital stays, improve the experience for patients and lower costs.
Experts compared it to the introduction of the surgical checklist in 2010 – a series of basic questions ("Is this the right patient?" "Is this the right limb?") – which has been shown to cut deaths after operations by a third, and complications by half. But producing the new chart with a National Early Warning Score – a composite measure of six vital signs that indicates when a patient needs urgent help – involved "banging heads together" across the NHS to get doctors to agree, according to Bryan Williams, the chair of the group that developed it. The professor of medicine at University College London, who first proposed the innovation in an earlier report in 2007, said there were at least 100 different hospital charts in use throughout the NHS with different scoring systems.
Doctors and nurses who moved between NHS trusts – or even between different wards in the same trust – found themselves confronted with a new chart and a different scoring system which they did not understand, putting patients at risk.
"Colleagues in various specialities developed early-warning systems of which they were justifiably proud and to which, in some cases, they were firmly wedded. But this was not just about 'What is the best system?' It was also about recognising the huge advantage of everyone using the same system," he said.
The six vital signs that comprise the score are temperature, pulse, breathing rate, blood pressure, blood-oxygen level and consciousness. The charts are colour-coded and any single measure that falls in a red zone – such as respiration below nine breaths a minute – should trigger a call to the medical team.
If the composite measure falls in the red zone, emergency assessment of the patient should be carried out by senior staff. A study published earlier this month found 1,000 patients a month were dying in NHS hospitals as a result of bungled care, most often because medical staff failed to spot or act on signs that patients were deteriorating.
Professor Williams said: "I think we could expect a 50 per cent reduction in morbidity and mortality as a result of implementing this.
"It is the first time in the world that anyone has tried to standardise the measurements [across all hospitals] in a healthcare system to drive up standards of care."
How the chart works
The observation chart records six vital signs, scored zero (low risk) to 3 (high risk), and is colour-coded to indicate when a danger level has been reached. If any single measure, e.g. temperature, is in the red zone, nurses must call a senior doctor to assess the patient.
In addition to recording each individual vital sign, the chart also displays a composite measure of all six – the National Early Warning Score. A patient with an overall score of zero to four is designated low risk and should be checked by a nurse every four to six hours. A score of seven or more indicates an emergency with immediate intervention by a specialist required.
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