The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics
Abstract We aimed to assess the frequency of value preferences in recording of vital signs in electronic healthcare records (EHRs) and associated patient and hospital factors. We used EHR data from Oxford University Hospitals, UK, between 01-January-2016 and 30-June-2019 and a maximum likelihood est...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-03-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-30691-z |
| _version_ | 1797864960626262016 |
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| author | Niall Jackson Jessica Woods Peter Watkinson Andrew Brent Tim E. A. Peto A. Sarah Walker David W. Eyre |
| author_facet | Niall Jackson Jessica Woods Peter Watkinson Andrew Brent Tim E. A. Peto A. Sarah Walker David W. Eyre |
| author_sort | Niall Jackson |
| collection | DOAJ |
| description | Abstract We aimed to assess the frequency of value preferences in recording of vital signs in electronic healthcare records (EHRs) and associated patient and hospital factors. We used EHR data from Oxford University Hospitals, UK, between 01-January-2016 and 30-June-2019 and a maximum likelihood estimator to determine the prevalence of value preferences in measurements of systolic and diastolic blood pressure (SBP/DBP), heart rate (HR) (readings ending in zero), respiratory rate (multiples of 2 or 4), and temperature (readings of 36.0 °C). We used multivariable logistic regression to investigate associations between value preferences and patient age, sex, ethnicity, deprivation, comorbidities, calendar time, hour of day, days into admission, hospital, day of week and speciality. In 4,375,654 records from 135,173 patients, there was an excess of temperature readings of 36.0 °C above that expected from the underlying distribution that affected 11.3% (95% CI 10.6–12.1%) of measurements, i.e. these observations were likely inappropriately recorded as 36.0 °C instead of the true value. SBP, DBP and HR were rounded to the nearest 10 in 2.2% (1.4–2.8%) and 2.0% (1.3–5.1%) and 2.4% (1.7–3.1%) of measurements. RR was also more commonly recorded as multiples of 2. BP digit preference and an excess of temperature recordings of 36.0 °C were more common in older and male patients, as length of stay increased, following a previous normal set of vital signs and typically more common in medical vs. surgical specialities. Differences were seen between hospitals, however, digit preference reduced over calendar time. Vital signs may not always be accurately documented, and this may vary by patient groups and hospital settings. Allowances and adjustments may be needed in delivering care to patients and in observational analyses and predictive tools using these factors as outcomes or exposures. |
| first_indexed | 2024-04-09T23:00:15Z |
| format | Article |
| id | doaj.art-10237911e44246a3804fb8fc76b39cd7 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-09T23:00:15Z |
| publishDate | 2023-03-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-10237911e44246a3804fb8fc76b39cd72023-03-22T10:59:48ZengNature PortfolioScientific Reports2045-23222023-03-0113111210.1038/s41598-023-30691-zThe quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographicsNiall Jackson0Jessica Woods1Peter Watkinson2Andrew Brent3Tim E. A. Peto4A. Sarah Walker5David W. Eyre6Oxford University Hospitals NHS Foundation TrustN Family ClubNuffield Department of Clinical Neurosciences, University of OxfordOxford University Hospitals NHS Foundation TrustNuffield Department of Medicine, University of OxfordNuffield Department of Medicine, University of OxfordNIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of OxfordAbstract We aimed to assess the frequency of value preferences in recording of vital signs in electronic healthcare records (EHRs) and associated patient and hospital factors. We used EHR data from Oxford University Hospitals, UK, between 01-January-2016 and 30-June-2019 and a maximum likelihood estimator to determine the prevalence of value preferences in measurements of systolic and diastolic blood pressure (SBP/DBP), heart rate (HR) (readings ending in zero), respiratory rate (multiples of 2 or 4), and temperature (readings of 36.0 °C). We used multivariable logistic regression to investigate associations between value preferences and patient age, sex, ethnicity, deprivation, comorbidities, calendar time, hour of day, days into admission, hospital, day of week and speciality. In 4,375,654 records from 135,173 patients, there was an excess of temperature readings of 36.0 °C above that expected from the underlying distribution that affected 11.3% (95% CI 10.6–12.1%) of measurements, i.e. these observations were likely inappropriately recorded as 36.0 °C instead of the true value. SBP, DBP and HR were rounded to the nearest 10 in 2.2% (1.4–2.8%) and 2.0% (1.3–5.1%) and 2.4% (1.7–3.1%) of measurements. RR was also more commonly recorded as multiples of 2. BP digit preference and an excess of temperature recordings of 36.0 °C were more common in older and male patients, as length of stay increased, following a previous normal set of vital signs and typically more common in medical vs. surgical specialities. Differences were seen between hospitals, however, digit preference reduced over calendar time. Vital signs may not always be accurately documented, and this may vary by patient groups and hospital settings. Allowances and adjustments may be needed in delivering care to patients and in observational analyses and predictive tools using these factors as outcomes or exposures.https://doi.org/10.1038/s41598-023-30691-z |
| spellingShingle | Niall Jackson Jessica Woods Peter Watkinson Andrew Brent Tim E. A. Peto A. Sarah Walker David W. Eyre The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics Scientific Reports |
| title | The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics |
| title_full | The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics |
| title_fullStr | The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics |
| title_full_unstemmed | The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics |
| title_short | The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics |
| title_sort | quality of vital signs measurements and value preferences in electronic medical records varies by hospital specialty and patient demographics |
| url | https://doi.org/10.1038/s41598-023-30691-z |
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