DOI: 10.1097/01.ccm.0000425035.00021.e7
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Issn Print: 0090-3493
Publication Date: 2012/12/01
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Abstract
Introduction:Automated measurements that go otherwise unobserved can herald sentinel clinical events. While automated polling of monitor data into EHRs has eliminated transcription errors and reflects vital sign data at specific time points, important hemodynamic events between charted data are missed. The purpose of this study was to count the missed sentinel events and correlate with mortality.
Hypothesis:The purpose of this study was to count the missed sentinel events and correlate with mortality.
Methods:Mean arterial pressure (MAP) data were validated by a nurse and automatically recorded by a bedside monitor system were compared for all patients. Patients with less than 4 nurse validations or 10 automated recordings were removed. Erroneous MAP values were eliminated and automatically recorded values were smoothed utilizing a median value method. Hypotension events were defined as 10 successive MAP values less than 55 in the automatically recorded values. These events were noted as missed if the next nurse recording of MAP exceeded 55. We compared the number of missed events between survivors and non-survivors.
Results:In this pilot study of 5 months, 137/239 patients had sufficient data. 48/137 had hypotension events, 23 expired and 25 survived to ICU discharge. A total of 293 events occurred in the automatic recordings of which 103 were missed. In expired patients, 48/182 (26%) events went undocumented. In surviving patients, 55/111 (50%) events were missed. The total number of monitored hours for the expired patients was 2259 and surviving patients was 5133 yielding a missed rate of 2% for every hour each patient is monitored.
Conclusions:Hypotension occurs in more than 1/3 of critically ill patients, and 1/3 of hypotension events go undocumented in the official medical record, collectively suggesting frequent loss of situation awareness. The clinical significance of such misses and loss of awareness is unknown, but events appear to be more frequent among survivors suggesting increased surveillance in more acute patients. Earlier identification of these hypotension events has the potential to improve outcomes through prompt treatment of life-threatening states.
