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Research Letter |

A Prospective Study of Nighttime Vital Sign Monitoring Frequency and Risk of Clinical Deterioration

Jordan C. Yoder, BA1; Trevor C. Yuen, BA2; Matthew M. Churpek, MD, MPH2; Vineet M. Arora, MD, MAPP2; Dana P. Edelson, MD, MS2
[+] Author Affiliations
1Pritzker School of Medicine, University of Chicago, Chicago, Illinois
2Section of Hospital Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
JAMA Intern Med. 2013;173(16):1554-1555. doi:10.1001/jamainternmed.2013.7791.
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The routine practice of collecting vital signs every 4 hours in hospitalized ward patients has been perpetuated since as early as 1893, but little evidence supports this tradition.1 Although vital signs can be indicative of impending clinical deterioration, routine nighttime vital sign monitoring adds to the already fragmented sleep of inpatients. Sleep disruptions are prevalent among ward patients and are associated with several negative health outcomes, including elevated blood pressure and delirium.2,3 Overnight vital sign checks not only are an especially bothersome disrupter but also can deplete crucial health care resources. Track and trigger systems, such as the Modified Early Warning Score (MEWS), have been used to identify high-risk patients for critical interventions.4 The present study investigated whether the MEWS could identify low-risk patients who might forgo overnight vital sign monitoring.

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Figure.
Adverse Event Rate and Evening Modified Early Warning Score

The bars represent the adverse event rate (per 1000 patient-days). The line represents nighttime vital sign monitoring (per patient median).

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