RCEM national QIP finds EDs making significant improvements in the process of repeating and acting upon abnormal vital signs in adults

22 July 2019

The Royal College of Emergency Medicine’s 2018/9 Vital Signs in Adults Quality Improvement Project (QIP) of Emergency Departments (EDs) has found there has been significant improvement in the repeat measurement of vital signs and of appropriate actions taken in EDs.

The QIP was the first since the clinical audit in 2010/11, with a total of 20,960 patients from 190 EDs having their documented care reviewed.

The QIP found:

• EDs are encouraged to repeat observations of patient’s vital signs (respiratory rate, oxygen saturation, pulse, blood pressure, alertness and temperature) with 60 minutes if they were abnormal. The QIP found that this was achieved for a mean of 54%. In 2010/11 this was achieved for a median of 20% of patients.
• There was evidence that abnormal vital signs were acted upon in 71% of cases, this was an improvement since the last clinical audit.

President of the Royal College of Emergency Medicine, Dr Taj Hassan said: “These welcome improvements demonstrate the efforts of EDs to improve safety and the early recognition of patients in challenging conditions; crowded departments with ever increasing attendances.

“It is clear that departments are using newly developed tools to rise to these challenges by identifying and prioritising patients who have deteriorated.”

The QIP does however highlight areas for improvement:

• There are many patients arriving into the major’s area of departments who either have delayed, or incomplete vital signs observations.
• Over the course of the six-month project there has been no significant change in national performance in any area, however it is encouraging to see that performance against standards remains consistent over the busy winter period.
• It is likely that many departments have continued with the previous audit approach and not yet fully harnessed the upgraded QI functionality. With increased familiarity and publicity for the new approach, further training as part of the EM curriculum, and QIP examinations there is hope that next year will offer greater results in national quality improvement.
• Departments that have demonstrated local improvement are to be commended and are invited to share good practice.

Dr Hassan said: “The commitment of Emergency Departments to engage in quality improvement is a source of great pride to us. We applaud the enthusiasm with which departments have embraced our new style of national clinical audit with integrated QIP methodology. RCEM recognises the pressurised environment most departments continue to work in and is keen to support their fantastic efforts by keeping this QIP open online for to use locally whenever required.

“We encourage all departments to consider how they can make progress on the three recommendations, particularly if their data shows that this is currently a challenging area for them.

Chair of the RCEM Quality Assurance and Improvement Sub-Committee, Dr Elizabeth Saunders said, “The majority of EDs are now using standardised scoring system to identify acutely ill and deteriorating patients. Such standardised systems used early and regularly have great advantages for patient management. Data collected in this project shows that 84% of patient notes have documented use of a standardised scoring system. We want to get this figure up to 100% so we can all benefit from the advantages of using a standardised system in our departments.”

To improve the care of patients presenting with abnormal vital signs in adults, RCEM makes three key recommendations:

1. Departments struggling to meet the challenge of measuring a complete set of vital signs within 15 minutes of arrival should review their process and consider how they can learn from higher performing Trusts.
2. Departments are encouraged to use the RCEM QI platform to support their QI activities.
3. Departments not achieving repeat vital signs within 60 minutes, should review their results and consider how to effect improvement.

-ENDS-

Notes to Editors
Vital Signs in Adults 2018/19 is one of three QIPs published by the Royal College of Emergency Medicine in July 2019.
The purpose of the QIP was to monitor documented care against the standards published in July 2018, and to facilitate improved care using QIP methodology and weekly data feedback.
QIP methodology was promoted to encourage EDs to improve towards more consistent delivery of these standards, helping clinicians examine the work they do day-to-day, benchmark against their peers, and to recognise excellence.
A total of 20,960 patients presenting to 190 Emergency Departments were included in this QIP. Previously, an audit of vital signs was conducted in 2010/11. However, this was the first time the topic had been run with an integrated QIP.
If you have any queries about the report, please e-mail audit@rcem.ac.uk or phone 020 0674812.