Implementation of an Evidence-Based Guideline to Improve Vital Sign Assessment and Documentation in the Emergency Department

BACKGROUND: The emergency department (ED) is a fast-paced area at risk for medical errors. Studies have found that patients with abnormal vital signs (VS) experience preventable adverse events and worse process outcomes, such as extended length of stay (LOS) times and increased readmission rates. Despite ongoing reports of VS inconsistencies, there remains a lack of evidence-based VS assessment and documentation standards across healthcare, which results in missed opportunities to mitigate deficits in quality of care.

LOCAL PROBLEM: The project site, a 19-bed rural ED in Maryland, lacked a standardized process delineating VS assessment frequency for the ED nurses, resulting in VS inconsistencies and potential harm. This project aimed to increase the frequency of the ED nurses’ VS assessment and documentation by more than 50% within 90 days of implementation.

METHODS: The Model for Improvement (MFI) guided this QI project. Plan-Do-Study-Act (PDSA) cycles were used to develop and implement the guideline. Pre- and post-implementation data were collected via retrospective chart reviews to compare the VS documentation compliance per guideline recommendations. LOS was also compared as a balancing measure.

INTERVENTIONS: Current literature was used to develop and implement an evidence-based guideline recommending VS assessment and reassessment documentation frequencies based on acuity. Educational sessions were provided for staff.

RESULTS: Heart rate, blood pressure, respiratory rate, pulse oxygenation, and pain documentation significantly increased over 100% from pre- to post-implementation. Temperature compliance increased by 7.4%. Documentation of VS within 60 minutes of the patient departing the ED increased by 68.6%. LOS decreased from 238 to 165 minutes.

CONCLUSIONS: Using an evidence-based VS assessment and reassessment guideline for ED nurses significantly improved VS documentation compliance in all VS except temperature in this setting. Future studies focusing on temperature documentation are recommended. Consistent VS assessments and documentation are crucial in improving patient care and departmental metrics.