%0 Journal Article
%@ 2291-9694
%I JMIR Publications
%V 6
%N 4
%P e10221
%T Impact of Electronic Versus Paper Vital Sign Observations on Length of Stay in Trauma Patients: Stepped-Wedge, Cluster Randomized Controlled Trial
%A Wong,David CW
%A Knight,Julia
%A Birks,Jacqueline
%A Tarassenko,Lionel
%A Watkinson,Peter J
%+ Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Worsley Building, Level 10, Leeds, LS29JT, United Kingdom, 44 113 3439671, d.c.wong@leeds.ac.uk
%K vital signs
%K medical records system, computerized
%K length of stay
%K evaluation studies
%K trauma
%D 2018
%7 31.10.2018
%9 Original Paper
%J JMIR Med Inform
%G English
%X 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) 
%M 30381284
%R 10.2196/10221
%U http://medinform.jmir.org/2018/4/e10221/
%U https://doi.org/10.2196/10221
%U http://www.ncbi.nlm.nih.gov/pubmed/30381284