Indicators of patient deterioration in poorly resourced private hospitals: Which vital sign to watch? A retrospective case–control study

Background:Patientvitalsignsareameasureofwellnessifmonitoredregularlyandaccurately.Staff shortagesinpoorlyresourcedregionalhospitalsoftenresultininadequatepatientmonitoring,putting patientsatriskofundetecteddeterioration. Objective:Thisstudyaimstoexplorethepatternandcompletenessofvitalsignmonitoringandthe contributionofeachvitalsigninpredictingclinicaldeteriorationeventsinresource-poorregional/rural hospitals. Method:Usingaretrospectivecaseecontrolstudydesign,wecompared24hofvitalsigndatafrom deterioratingandnondeterioratingpatientsfromtwopoorly-resourcedregionalhospitals.Descriptive statistics,t-tests,andanalysisofvarianceareusedtocomparepatient-monitoringfrequencyand completeness.Thecontributionofeachvitalsigninpredictingpatientdeteriorationwasdetermined usingtheAreaUndertheReceiverOperatorCharacteristiccurveandbinarylogisticalregressionanalysis. Results:Deterioratingpatientsweremonitoredmorefrequently(9.58[7.02]times)inthe24-hperiod thannondeterioratingpatients(4.93[2.66]times).However,thecompletenessofvitalsigndocumentationwashigherinnondeteriorating(85.2%)thanindeterioratingpatients(57.7%).Bodytemperature wasthemostfrequentlyomittedvitalsign.Patientdeteriorationwaspositivelylinkedtothefrequencyof abnormalvitalsignsandthenumberofabnormalvitalsignsperset(AreaUndertheReceiverOperator Characteristiccurve:0.872and0.867,respectively).Nosinglevitalsignstronglypredictspatientoutcomes.However,asupplementaryoxygenvalueof>3L/minandaheartrateof>139beats/minwerethe bestpredictorsofpatientdeterioration. Conclusion:Giventhepoorresourcingandoftengeographicalremotenessofsmallregionalhospitals,it isprudentthatthenursingstaffaremadeawareofthevitalsignsthatbestindicatedeteriorationforthe cohortofpatientsintheircare.Tachycardicpatientsonsupplementaryoxygenareathighriskof deterioration.