The Factors that Affect the Frequency of Vital Sign Monitoring During Times of Emergency Department Crowding
Chris Burant, Case Western Reserve University 
Mary Dolansky, Case Western Reserve University 
*Kimberly D Johnson, Department of Veterans Affairs, Case Western Reserve University 
Vicken Totten, Case Western Reserve University 
Chris Winkelman, Case Western Reserve University  

Keywords: vital signs, emergency department, crowding, structural equation modeling

Aim: To examine patients’ vital signs and what factors may influence the time between recording vital signs in the Emergency Department (ED) during various levels of crowding.

Methods: A descriptive, retrospective chart review of 202 randomly selected adult ED patients' charts based on the Asplin Input/Throughput/Output Model of ED crowding. Sampling Plan: Strategic sampling at representative times captured a variety of ED levels of occupancy. Setting: Urban, Midwestern, teaching hospital. Analysis: Multiple regression, Correlation and Structural Equation Modeling (SEM). Results: The results of this study demonstrated that as crowding increased, the time between vital signs increased by 1.3 minutes per increase of 1 in the Emergency Department Work Index score, Several other factors correlated with the time between vital sign recordings: Length of stay correlated to an increase of 6 seconds for each minute increase, number of routes medications were delivered correlated to a decrease of 13 minutes for each additional route, triage category correlated to an increase of 35 minutes for less acute categories, number of comorbidities correlated to a decrease of 7 minutes for each additional co-morbidity, and patients arriving by private car had an increase of 35 minutes over patients arriving by ambulance. Conclusion Crowding and several other factors affects the frequency of vital sign monitoring in the ED. This study establishes a need to standardize the frequency of vital sign recording in the ED These findings are clinically important as greater time between vital sign recordings can lead to error of omission by not detecting changes in vital signs to uncover changes in the condition of patients. The findings of this study provide direction for future research focusing on determining if higher frequency of vital signs surveillance contributes to high quality care and linking quality of care to missing vital signs/inadequate monitoring.