So, this was an interesting article about a system of vital sign “triggers” an ED implemented to get nurses to flag specific patients for more urgent attention. Not unexpectedly, the study finds that, when nurses get physician’s attention, everything happens more rapidly to those patients, orders, antibiotics, and disposition. The problem is, the article doesn’t address the appropriateness or any unintended consequences of this sort of intervention. The theory would be that these abnormal vital signs represent patients that need more urgent evaluation, but vital signs are always just one piece of the puzzle. In any event, this study spotlights something that can be reasonably construed as important – nurses should be educated to recognize potentially ill patients and notify physicians.
Of course, in the back of my mind, I was envisioning our ED (and likely many around it) which rooms patients first, and then triages them – and it then becomes the responsibility of the nurse whose zone they have entered to take and record vital signs. This results in patients being roomed much faster – which many studies have shown is likely a good thing. Unfortunately, when a patient is roomed to the high-acuity side based on chief complaint, the nurse to which they are assigned may be quite busy with their other high-acuity patients…and that patient may just sit in the room for some time without an assessment or vital signs.
Everything has potential unintended consequences.