versão On-line ISSN 2078-5151
versão impressa ISSN 0038-2361
S. Afr. j. surg. vol.49 no.4 Cape Town Nov. 2011
W. W. D. StewartI; Z. FarinaII; D. L. ClarkeIII; S. R. ThomsonIV
I3rd-Year Medical Student; University of Pretoria
IIF.C.A.; Metropolitan Anaesthetic and Critical Care Service, Pietermaritzburg, and Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal
IIIF.C.S. (s.A.), M.Med.Sci., M.B.A.; Metropolitan Surgical Service, Pietermaritzburg, and Nelson R Mandela School of Medicine
IVF.R.C.S., Ch.M.; Metropolitan Surgical Service, Pietermaritzburg, and Nelson R Mandela School of Medicine
INTRODUCTION: Caring for trauma patients is a dynamic process, and it is often necessary to move the trauma patient around the hospital to different locations. This study attempted to document the quality of observations performed on acute trauma patients as they moved through the hospital during the first 24 hours of care.
METHODOLOGY: This study was a student elective and was undertaken at Grey's Hospital, Pietermaritzburg. A third-year medical student was assigned to follow acute trauma patients throughout the hospital during the first 24 hours after admission. This single independent observer recorded the frequency with which vital signs were recorded at each geographical location in the hospital for each patient. A scoring system was devised to classify the quality of the observations that each patient received in the different departments. The observer recorded all the geographical movements each patient made during the first 24 hours after admission.
RESULTS: Fifteen patients were recruited into this study over a 4-week period. There were 14 adult males (average age 28 years, range 18 - 56 years) and a 7-year-old girl in the cohort. There were significant differences in the quality of the observations, depending on the geographical location in the hospital. These variations and differences were consistent in certain locations and highly variable in others. Observations in the intensive care unit (ICU) and operating theatre were uniformly excellent. In the radiology suite the level of observations was universally poor. In casualty and the wards there was great variability in the level of observation. A total of 45 distinct geographical visits were made by the study cohort. Each patient made an average of 3 (range 2 - 5) visits during their first 24 hours after admission. All patients attended casualty, and there were 11 patient visits to the ward, 10 to radiology, 4 to ICU and 5 to theatre.
CONCLUSION: Significant variations exist in the level of observations of vital signs between different geographical locations within the hospital. This is problematic, as acute trauma patients need to be moved around the hospital as part of their routine care. If observations are not done and acted upon, subtle clinical deterioration may be overlooked and overt deterioration may be heralded by a catastrophic event.
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1. Subbe CP, Williams E, Fligelstone L, Gemmell L. Does earlier detection of critically ill patients on surgical wards lead to better outcomes? Ann R Coll Surg Engl 2005;87(4):226-232. [ Links ]
2. Donohue LA, Endacott R. Track, trigger and teamwork: Communication of deterioration in acute medical and surgical wards. Intensive Crit Care Nurs 2010;26(1):10-17. Epub 2009 Dec 5. [ Links ]
3. Johnstone CC, Rattray J, Myers L. Physiological risk factors, early warning scoring systems and organizational changes. Nurs Crit Care 2007;12(5):219-224. [ Links ]
4. Endacott R, Kidd T, Chaboyer W, Edington J. Recognition and communication of patient deterioration in a regional hospital: a multi-methods study. Aust Crit Care 2007;20(3):100-105. [ Links ]
5. Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 2004;32:916-921. [ Links ]
Ryan H, Cadman C, Hann L. Setting standards for assessment of ward patients at risk of deterioration. Br J Nurs 2004;13(20):1186-1190. [ Links ]
6. Subbe CP, Gao H, Harrison DA. Reproducibility of physiological track and trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med 2007;33(4):619-924. [ Links ]
7. Cuthbertson BH. Optimising early warning scoring systems. Resuscitation 200877(2):153-154. [ Links ]