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Introduction
Most readers will understandably pass by the piece by Hands et al,1 “Patterns in the recording of vital signs and early warning scores [EWSs]: the degree of compliance with a clinical escalation protocol.” The keywords ‘patterns’, ‘recording’, ‘vital signs’, ‘early warning scores’, ‘protocol’ and ‘compliance’ will attract only the most interested in this area. A complicated-looking methodology and the use of technical jargon and acronyms may even prevent skimming by casually interested readers. Even experts in this topic may pass over the paper, perhaps just giving it a quick glance and nodding in agreement that ‘we all know’—patient observations are either not taken or are taken incorrectly and that when they are taken and recorded correctly few clinicians take any interest in them.2
Study findings
That said, the prosaic sounding title and technical jargon belie the fundamental contribution this research represents with respect to efforts to improve the safety and quality of hospital care. To justify that claim we need to explain in plain English what the authors have done. Hands et al1 assembled a massive cohort including the vital signs of all adult patients over a 1-year period in a large National Health Service (NHS) District General Hospital in the UK using bedside observation data captured on an electronic system. This allowed for the analysis of nearly 1 million patient observation sets. They then asked two fundamental questions: first, what is the pattern of the observation capture (eg, how frequently do patients have vital signs checked, what proportions are abnormal and do abnormal recordings occur more frequently at certain times of day)? And second, but more importantly, to what extent do staff adhere to hospital policy such that abnormal findings trigger further, more frequent observations?
By way of background, it is important to understand that most NHS …