INTRODUCTION: Caring for trauma patients is a dynamic process,
and it is often necessary to move the trauma patient around the
hospital to different locations. This study attempted to document
the quality of observations performed on acute trauma
patients as they moved through the hospital during the first 24
hours of care.
METHODOLOGY: This study was a student elective and was
undertaken at Grey’s Hospital, Pietermaritzburg. A third-year
medical student was assigned to follow acute trauma patients
throughout the hospital during the first 24 hours after admission.
This single independent observer recorded the frequency
with which vital signs were recorded at each geographical
location in the hospital for each patient. A scoring system was
devised to classify the quality of the observations that each
patient received in the different departments. The observer
recorded all the geographical movements each patient made
during the first 24 hours after admission.
RESULTS: Fifteen patients were recruited into this study over
a 4-week period. There were 14 adult males (average age 28
years, range 18 - 56 years) and a 7-year-old girl in the cohort.
There were significant differences in the quality of the observations,
depending on the geographical location in the hospital.
These variations and differences were consistent in certain
locations and highly variable in others. Observations in the
intensive care unit (ICU) and operating theatre were uniformly
excellent. In the radiology suite the level of observations was
universally poor. In casualty and the wards there was great
variability in the level of observation. A total of 45 distinct
geographical visits were made by the study cohort. Each patient
made an average of 3 (range 2 - 5) visits during their first 24
hours after admission. All patients attended casualty, and there
were 11 patient visits to the ward, 10 to radiology, 4 to ICU and
5 to theatre.
CONCLUSION: Significant variations exist in the level of observations
of vital signs between different geographical locations
within the hospital. This is problematic, as acute trauma
patients need to be moved around the hospital as part of their routine care. If observations are not done and acted upon,
subtle clinical deterioration may be overlooked and overt deterioration
may be heralded by a catastrophic event.