title: Screening using the fifth vital sign in the electronic medical recording system.
abstract: OBJECTIVE
  To investigate the usefulness of screening for patient symptoms as the fifth vital sign using an electronic medical recording system.
  
  
  METHODS
  In the electronic medical recording system, all admitted patients received routine nurse-based assessment of discomfort (defined as any physical symptom) at every vital sign check regarding item 2 of the Support Team Assessment Schedule Japanese version (STAS-J). All cancer patients admitted to oncology units were screened at 1-week intervals. Screening-positive was defined when patients had a STAS-J score of 2 or more at least two times in a week. For all screening-positive patients, the palliative care team reviewed each patient's medical records, and provided written recommendations as needed. The primary outcomes were the proportion of screening-positive patient, and the proportion of patients deemed to need additional palliative treatment in the screening-positive patients.
  
  
  RESULTS
  Of 2427 patients screened, 223 (9.1%; 95% confidence interval, 8-10%) met the screening-positive criterion. A total of 12 (5.4%; 95% confidence interval, 3-9%) of them were deemed to need additional palliative care, including six patients referred to the PCT within 1 week. In the remaining 211 screening-positive patients, 100 had received adequate palliative care, 68 had already been referred to the palliative care team and 43 had self-limiting transient discomfort.
  
  
  CONCLUSIONS
  This screening system was feasible but the majority of screening-positive patients did not require additional palliative care interventions.
authors.affiliation: Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara Hospital.
authors.forename: Akemi Shirado
authors.initials: AS
authors.lastname: Naito
authors.affiliation: Palliative Care Team, Seirei Mikatahara Hospital.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Sakuma
authors.affiliation: Department of Palliative Care, Tokatsu Hospital.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Palliative Care Team, Seirei Mikatahara Hospital.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ito
authors.affiliation: Palliative Care Team, Seirei Mikatahara Hospital.
authors.forename: Saki
authors.initials: S
authors.lastname: Mimatsu
authors.affiliation: Palliative Care Team, Seirei Mikatahara Hospital.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tarumi
authors.affiliation: Nursing Department of Oncology Center, Seirei Mikatahara Hospital, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Kiyohara
authors.affiliation: Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara Hospital.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
mesh_terms: D000368:Aged; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening; D055986:Vital Signs
keywords: fifth vital sign; palliative care team; screening