Study shows fall in hospital death rates after computer software improves monitoring of patients' vital signs
Death rates at two large UK hospitals fell by more than 15% after nurses started using handheld computers instead of paper charts to record patients' vital signs, according to new research co-authored by University of Bradford's Professor Mohammed A Mohammed.
The study, published in BMJ Quality & Safety today, revealed a drop in mortality representing more than 750 lives saved in a single year across the two hospitals in Portsmouth and Coventry.
Nurses record patients’ blood pressure, pulse, oxygen levels and other indicators and calculate an 'Early Warning Score' (EWS) to monitor whether the patient is stable or deteriorating. These complex calculations are easy to get wrong when done using pen and paper in a pressured hospital environment.
In the study, the nurses use handheld devices to record the information and specialist software, called VitalPAC, which automatically calculates the EWS. If the patient's EWS gives cause for concern, the nurse is alerted to monitor the patient more frequently and, in some cases, to inform a doctor or a rapid response team.
The system was developed by doctors and nurses at Portsmouth together with health improvement company The Learning Clinic. It was introduced at Queen Alexandra Hospital, Portsmouth in 2005 and at University Hospital, Coventry in 2007. This was followed by a fall of almost 400 deaths among patients in one year at Queen Alexandra Hospital, and a drop of more than 370 in the same period at University Hospital, Coventry, according to the research.
Bradford's Professor Mohammed, an expert in patient safety, advised the clinical team on statistical methodology and helped to guide the analysis of the data. He said: "It is easy to blame staff for the failures in the quality of care especially in respect of calculating risk scores for patients in busy hospital wards. But if we replaced all the staff with new staff, error rates would remain about the same. The smart thing to do is to change the system, not the staff.
"Here is an excellent example of a well-engineered, clinically-led IT solution. It was developed to 'design out' human error when collecting and documenting important clinical data and it supports ward staff to take appropriate action, resulting in improved quality of care."
An accompanying editorial in BMJ Quality & Safety described the research as "an important milestone" in improving patient safety and said the lowering of mortality at these two hospitals "represents a truly dramatic improvement."
"The marriage between healthcare and IT can be difficult and often ends in divorce," says Professor Mohammed. "A simple way to know if an IT system is helping front line clinical staff is to see if they will let you take it away - and often staff are pleased to see IT systems laid to rest. But in this case, staff will not happily allow this system to be withdrawn because it helps them to care for their patients - and this is what really matters to them."