Impact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised study
<strong>Background.</strong> Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. <strong>Objective.</strong> To assess the effect of e-Obs versus paper d...
| Main Authors: | , , , , |
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| Format: | Journal article |
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JMIR Publications
2018
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| _version_ | 1797090937593135104 |
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| author | Wong, D Knight, J Birks, J Tarassenko, L Watkinson, P |
| author_facet | Wong, D Knight, J Birks, J Tarassenko, L Watkinson, P |
| author_sort | Wong, D |
| collection | OXFORD |
| description | <strong>Background.</strong> Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. <strong>Objective.</strong> To assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and ‘fit to discharge’) for trauma patients. <strong>Methods.</strong> A single centre randomised stepped-wedge study of e-Obs against paper in two 26-bed trauma wards at a medium-sized UK teaching hospital. Randomisation of the phased intervention order to the 12 study areas was computer-generated. The primary outcome was length of stay. <strong>Results.</strong> 1232 patient episodes were randomised (paper: 628, e-Obs: 604). There were 37 deaths in hospital, 21 in the Paper arm and 16 in the e-Obs arm. For discharged patients the median length of stay was 5.4 days (range: 0.2 to 79.0) on paper and 5.6 days (range: 0.1 to 236.7) on e-Obs arm. Competing risks regression analysis for time to discharge showed no difference between the treatment arms, subhazard ratio: 1.05 (0.82, 1.35) P=.68. More patient episodes contained an EWS≥3 using the e-Obs system than paper, subhazard ratio 1.63 (95% CI 1.28, 2.09 P<0.001). However, there was no difference in the time to the subsequent observation (‘escalation time’) hazard ratio 1.05 (95% CI 0.80, 1.38 P=.70). <strong>Conclusions.</strong> The phased introduction of an e-Obs documentation system was not associated with a change in length of stay. More patient episodes contained an EWS≥3 using the e-Obs system, but this was not associated with a change in ‘escalation time’. |
| first_indexed | 2024-03-07T03:25:50Z |
| format | Journal article |
| id | oxford-uuid:b8ffb309-b809-4c2f-9abc-25e14f483c62 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T03:25:50Z |
| publishDate | 2018 |
| publisher | JMIR Publications |
| record_format | dspace |
| spelling | oxford-uuid:b8ffb309-b809-4c2f-9abc-25e14f483c622022-03-27T04:59:57ZImpact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b8ffb309-b809-4c2f-9abc-25e14f483c62Symplectic Elements at OxfordJMIR Publications2018Wong, DKnight, JBirks, JTarassenko, LWatkinson, P<strong>Background.</strong> Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. <strong>Objective.</strong> To assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and ‘fit to discharge’) for trauma patients. <strong>Methods.</strong> A single centre randomised stepped-wedge study of e-Obs against paper in two 26-bed trauma wards at a medium-sized UK teaching hospital. Randomisation of the phased intervention order to the 12 study areas was computer-generated. The primary outcome was length of stay. <strong>Results.</strong> 1232 patient episodes were randomised (paper: 628, e-Obs: 604). There were 37 deaths in hospital, 21 in the Paper arm and 16 in the e-Obs arm. For discharged patients the median length of stay was 5.4 days (range: 0.2 to 79.0) on paper and 5.6 days (range: 0.1 to 236.7) on e-Obs arm. Competing risks regression analysis for time to discharge showed no difference between the treatment arms, subhazard ratio: 1.05 (0.82, 1.35) P=.68. More patient episodes contained an EWS≥3 using the e-Obs system than paper, subhazard ratio 1.63 (95% CI 1.28, 2.09 P<0.001). However, there was no difference in the time to the subsequent observation (‘escalation time’) hazard ratio 1.05 (95% CI 0.80, 1.38 P=.70). <strong>Conclusions.</strong> The phased introduction of an e-Obs documentation system was not associated with a change in length of stay. More patient episodes contained an EWS≥3 using the e-Obs system, but this was not associated with a change in ‘escalation time’. |
| spellingShingle | Wong, D Knight, J Birks, J Tarassenko, L Watkinson, P Impact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised study |
| title | Impact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised study |
| title_full | Impact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised study |
| title_fullStr | Impact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised study |
| title_full_unstemmed | Impact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised study |
| title_short | Impact of electronic versus paper vital sign observations on length-of-stay in trauma patients: stepped-wedge cluster randomised study |
| title_sort | impact of electronic versus paper vital sign observations on length of stay in trauma patients stepped wedge cluster randomised study |
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