• standards of Care
• safety culture
• interruptions
• human error
• cognitive biases

The importance of the respiratory rate (RR) as a vital sign is hardly new, but the recent article by Badawy et al 1 uses an elegant and scientific approach to shine new light on an old issue, that of the reliability of recorded vital signs. The article relates to an important function of healthcare: early detection and prevention of patient deterioration. From where I write, in Australia, recognising and responding to deterioration is one of ten National Health Standards.2 I believe RR is a microcosm of the challenges we face in healthcare and Badawy’s article has implications for patient safety and quality as a whole.

RR is an extremely valuable indicator; it is an integral part of early warning systems (EWS) and a diagnostic criterion for systemic inflammatory response syndrome.3 Its prognostic value can even rival complex prognostic tools such as the Pneumonia Severity Score.4 The changes in RR in a deteriorating patient are more pronounced than for heart rate and blood pressure.5 Therefore, RR is a highly sensitive, early marker for patient deterioration6 and highly predictive for in-hospital arrest and ICU admission.7 Apart from comorbidity, RR …