title: Frequency of vital sign assessment and clinical deterioration in an Australian emergency department.
abstract: BACKGROUND
  Understanding of clinical deterioration of emergency department patients is rapidly evolving. The aim of this study was to investigate the frequency and nature of vital sign collection and clinical deterioration in emergency care.
  
  
  METHODS
  A descriptive exploratory approach was used. Data were collected from the records of 200 randomly selected adults with presenting complaints of abdominal pain, shortness of breath, chest pain and febrile illness from 1 January to 31 December 2014 at a 22 bed emergency department in Melbourne, Australia.
  
  
  RESULTS
  When controlled for length of stay, heart rate was the most frequently assessed vital sign per hour (median=0.9) whilst Glasgow Coma Score was the least frequently assessed vital sign per hour (median=0.5). Clinical deterioration (one or more vital signs fulfilling hospital medical emergency team activation criteria during emergency department care) occurred in 14.5% of patients. Of the 5466 vital sign measures, 19.6% were abnormal, 1.9% indicated clinical deterioration.
  
  
  CONCLUSIONS
  Clinical deterioration occurred in one in seven patients, and one in five vital signs documented were outside of accepted normal ranges. Thus, emergency department physiological status has implications for patient safety and nursing practice, in particular clinical handover for patients requiring hospital admission.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Nursing and Midwifery Education and Strategy, Monash Health, c/- Deakin University, Geelong, Victoria, 3125, Australia. Electronic address: k.lambe@deakin.edu.au.
authors.forename: Katherine
authors.initials: K
authors.lastname: Lambe
authors.affiliation: School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, c/- Deakin University, Geelong, Victoria, 3125, Australia. Electronic address: judy.currey@deakin.edu.au.
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
authors.affiliation: School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University Eastern Health, Deakin University Nursing & Midwifery Research Centre, c/- Deakin University, Geelong, Victoria, 3125, Australia. Electronic address: julie.considine@deakin.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000503:physiopathology; D000328:Adult; D001794:Blood Pressure; D001831:Body Temperature; D002637:Chest Pain / Q000175:diagnosis / Q000503:physiopathology; D016638:Critical Illness; D004417:Dyspnea / Q000175:diagnosis / Q000503:physiopathology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005334:Fever / Q000175:diagnosis / Q000503:physiopathology; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data*; D010100:Oxygen / Q000097:blood; D056152:Respiratory Rate; D018570:Risk Assessment; D013997:Time Factors; D014739:Victoria; D055986:Vital Signs
chemical_list: D010100:Oxygen
keywords: Clinical deterioration; Emergency department; Emergency nursing; Patient assessment; Patient safety; Risk assessment; Vital signs