Summary
Background: Computerized clinical decision support and automation of warnings have been advocated
to assist clinicians in detecting patients at risk of physiological instability. To
provide reliable support such systems are dependent on high-quality vital sign data.
Data quality depends on how, when and why the data is captured and/or documented.
Objectives: This study aims to describe the effects on data quality of vital signs by three
different types of documentation practices in five Swedish emergency hospitals, and
to assess data fitness for calculating warning and triage scores. The study also provides
reference data on triage vital signs in Swedish emergency care.
Methods: We extracted a dataset including vital signs, demographic and administrative data
from emergency care visits (n=335027) at five Swedish emergency hospitals during 2013
using either completely paper-based, completely electronic or mixed documentation
practices. Descriptive statistics were used to assess fitness for use in emergency
care decision support systems aiming to calculate warning and triage scores, and data
quality was described in three categories: currency, completeness and correctness.
To estimate correctness, two further categories –plausibility and concordance –were
used.
Results: The study showed an acceptable correctness of the registered vital signs irrespectively
of the type of documentation practice. Completeness was high in sites where registrations
were routinely entered into the Electronic Health Record (EHR). The currency was only
acceptable in sites with a completely electronic documentation practice.
Conclusion: Although vital signs that were recorded in completely electronic documentation practices
showed plausible results regarding correctness, completeness and currency, the study
concludes that vital signs documented in Swedish emergency care EHRs cannot generally
be considered fit for use for calculation of triage and warning scores. Low completeness
and currency were found if the documentation was not completely electronic.
Citation: Skyttberg N, Chen R, Blomqvist H, Koch S. Exploring Vital Sign Data Quality in Electronic
Health Records with Focus on Emergency Care Warning Scores. Appl Clin Inform 2017;
8: 880–892 https://doi.org/10.4338/ACI-2017-05-RA-0075
Keywords
Vital signs - data quality - emergency medicine - electronic health records - clinical
decision support systems.
