@Article{info:doi/10.2196/10221,
author="Wong, David CW
and Knight, Julia
and Birks, Jacqueline
and Tarassenko, Lionel
and Watkinson, Peter J",
title="Impact of Electronic Versus Paper Vital Sign Observations on Length of Stay in Trauma Patients: Stepped-Wedge, Cluster Randomized Controlled Trial",
journal="JMIR Med Inform",
year="2018",
month="Oct",
day="31",
volume="6",
number="4",
pages="e10221",
keywords="vital signs; medical records system, computerized; length of stay; evaluation studies; trauma",
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) ",
issn="2291-9694",
doi="10.2196/10221",
url="http://medinform.jmir.org/2018/4/e10221/",
url="https://doi.org/10.2196/10221",
url="http://www.ncbi.nlm.nih.gov/pubmed/30381284"
}