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How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study

How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study
How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study

Introduction: Monitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered. Objective: To estimate the time taken to measure and record one set of patient's vital signs; and to identify factors associated with the time required to measure and record one set of patient's vital signs. Methods: We undertook a time-and-motion study of 16 acute medical or surgical wards across four hospitals in England. Two trained observers followed a standard operating procedure to record the time taken to measure and record vital signs. We used mixed-effects models to estimate the mean time using whole vital signs rounds, which included equipment preparation, time spent taking vital signs at the bedside, vital signs documentation, and equipment storing. We tested whether our estimates were influenced by nurse, ward and hospital factors. Results: After excluding non-vital signs related interruptions, dividing the length of a vital signs round by the number of vital signs assessments in that round yielded an estimated time per vital signs set of 5 min and 1 second (95% Confidence Interval (CI) = 4:39–5:24). If interruptions within the round were included, the estimated time was 6:26 (95% CI = 6:01–6:50). If only time taking each patient's vital signs at the bedside was considered, after excluding non-vital signs related interruptions, the estimated time was 3:45 (95% CI = 3:32–3:58). We found no substantial differences by hospital, ward or nurse characteristics, despite different systems for recording vital signs being used across the hospitals. Discussion: The time taken to observe and record a patient's vital signs is considerable, so changes to recommended assessment frequency could have major workload implications. Variation in estimates derived from previous studies may, in part, arise from a lack of clarity about what was included in the reported times. We found no evidence that nurses save time when using electronic vital signs recording, or that the grade of staff measuring the vital signs influenced the time taken. Conclusions: Measuring and recording vital signs is time consuming and the impact of interruptions and preparation away from the bedside is considerable. When considering the nursing workload around vital signs assessment, no assumption of relative efficiency should be made if different technologies or staff groups are deployed.

Monitoring and surveillance, Nursing, Observation, Time-and-motion, Vital signs, Workload
0020-7489
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Hope, Joanna
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Briggs, Jim
9ed71b2f-ab3b-4122-be12-77861a482e97
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Gerry, Stephen
cafb3afb-ff64-4a95-84cd-ef88799312fa
Redfern, Oliver
fbfa43f6-3677-4bbf-a261-09f8baf96e27
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Hope, Joanna
5d49099e-13bc-49d2-88d8-48e1ec6d25fc
Briggs, Jim
9ed71b2f-ab3b-4122-be12-77861a482e97
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Gerry, Stephen
cafb3afb-ff64-4a95-84cd-ef88799312fa
Redfern, Oliver
fbfa43f6-3677-4bbf-a261-09f8baf96e27

Dall'ora, Chiara, Griffiths, Peter, Hope, Joanna, Briggs, Jim, Jones, Jeremy, Gerry, Stephen and Redfern, Oliver (2021) How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study. International Journal of Nursing Studies, 118, [103921]. (doi:10.1016/j.ijnurstu.2021.103921).

Record type: Article

Abstract

Introduction: Monitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered. Objective: To estimate the time taken to measure and record one set of patient's vital signs; and to identify factors associated with the time required to measure and record one set of patient's vital signs. Methods: We undertook a time-and-motion study of 16 acute medical or surgical wards across four hospitals in England. Two trained observers followed a standard operating procedure to record the time taken to measure and record vital signs. We used mixed-effects models to estimate the mean time using whole vital signs rounds, which included equipment preparation, time spent taking vital signs at the bedside, vital signs documentation, and equipment storing. We tested whether our estimates were influenced by nurse, ward and hospital factors. Results: After excluding non-vital signs related interruptions, dividing the length of a vital signs round by the number of vital signs assessments in that round yielded an estimated time per vital signs set of 5 min and 1 second (95% Confidence Interval (CI) = 4:39–5:24). If interruptions within the round were included, the estimated time was 6:26 (95% CI = 6:01–6:50). If only time taking each patient's vital signs at the bedside was considered, after excluding non-vital signs related interruptions, the estimated time was 3:45 (95% CI = 3:32–3:58). We found no substantial differences by hospital, ward or nurse characteristics, despite different systems for recording vital signs being used across the hospitals. Discussion: The time taken to observe and record a patient's vital signs is considerable, so changes to recommended assessment frequency could have major workload implications. Variation in estimates derived from previous studies may, in part, arise from a lack of clarity about what was included in the reported times. We found no evidence that nurses save time when using electronic vital signs recording, or that the grade of staff measuring the vital signs influenced the time taken. Conclusions: Measuring and recording vital signs is time consuming and the impact of interruptions and preparation away from the bedside is considerable. When considering the nursing workload around vital signs assessment, no assumption of relative efficiency should be made if different technologies or staff groups are deployed.

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How long do nursing staff take to measure and record patients’ vital signs observations in hospital A time-and-motion study - Accepted Manuscript
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Accepted/In Press date: 24 February 2021
e-pub ahead of print date: 3 March 2021
Published date: 3 March 2021
Additional Information: Funding This report presents independent research funded by the UK's National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (award number 17/05/03). The views and opinions expressed in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the Health Services and Delivery Research Programme or the Department of Health and Social Care.
Keywords: Monitoring and surveillance, Nursing, Observation, Time-and-motion, Vital signs, Workload

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Local EPrints ID: 447518
URI: http://eprints.soton.ac.uk/id/eprint/447518
ISSN: 0020-7489
PURE UUID: 8be288c5-a2de-495e-bcc8-d42b3c9cf8c0
ORCID for Chiara Dall'ora: ORCID iD orcid.org/0000-0002-6858-3535
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for Joanna Hope: ORCID iD orcid.org/0000-0002-8939-7045

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Date deposited: 15 Mar 2021 17:30
Last modified: 06 Jun 2024 04:22

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Contributors

Author: Chiara Dall'ora ORCID iD
Author: Peter Griffiths ORCID iD
Author: Joanna Hope ORCID iD
Author: Jim Briggs
Author: Jeremy Jones
Author: Stephen Gerry
Author: Oliver Redfern

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