Impact of Electronic Versus Paper Vital Sign Observations on Length of Stay in Trauma Patients: Stepped-Wedge, Cluster Randomized Controlled Trial

David Cw Wong; Julia Knight; Jacqueline Birks; Lionel Tarassenko; Peter J Watkinson

doi:10.2196/10221

Impact of Electronic Versus Paper Vital Sign Observations on Length of Stay in Trauma Patients: Stepped-Wedge, Cluster Randomized Controlled Trial

JMIR Med Inform. 2018 Oct 31;6(4):e10221. doi: 10.2196/10221.

Authors

David Cw Wong¹, Julia Knight², Jacqueline Birks³, Lionel Tarassenko⁴, Peter J Watkinson²

Affiliations

¹ Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
² Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
³ Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
⁴ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.

PMID: 30381284
PMCID: PMC6236204
DOI: 10.2196/10221

Abstract

Background: Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed.

Objective: The objective of our study was to assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and "fit to discharge") for trauma patients.

Methods: A single-center, randomized stepped-wedge study of e-Obs against paper was conducted in two 26-bed trauma wards at a medium-sized UK teaching hospital. Randomization of the phased intervention order to 12 study areas was computer generated. The primary outcome was length of stay.

Results: A total of 1232 patient episodes were randomized (paper: 628, e-Obs: 604). There were 37 deaths in hospital: 21 in the paper arm and 16 in the e-Obs arm. For discharged patients, the median length of stay was 5.4 (range: 0.2-79.0) days on the paper arm and 5.6 (range: 0.1-236.7) days on the e-Obs arm. Competing risks regression analysis for time to discharge showed no difference between the treatment arms (subhazard ratio: 1.05; 95% CI 0.82-1.35; P=.68). A greater proportion of patient episodes contained an Early Warning Score (EWS) ≥3 using the e-Obs system than using paper (subhazard ratio: 1.63; 95% CI 1.28-2.09; P<.001). However, there was no difference in the time to the subsequent observation, "escalation time" (hazard ratio 1.05; 95% CI 0.80-1.38; P=.70).

Conclusions: The phased introduction of an e-Obs documentation system was not associated with a change in length of stay. A greater proportion of patient episodes contained an EWS≥3 using the e-Obs system, but this was not associated with a change in "escalation time."

Trial registration: ISRCTN Registry ISRCTN91040762; http://www.isrctn.com/ISRCTN91040762 (Archived by WebCite at http://www.webcitation.org/72prakGTU).

Keywords: evaluation studies; length of stay; medical records system, computerized; trauma; vital signs.

©David CW Wong, Julia Knight, Jacqueline Birks, Lionel Tarassenko, Peter J Watkinson. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 31.10.2018.