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The "OBS" chart: an evidence based approach to re-design of the patient observation chart in a district general hospital setting

¹ Department of Medicine, North West London Hospitals NHS Trust (Central Middlesex Hospital), London, UK
² Department of Nursing, North West London Hospitals NHS Trust (Central Middlesex Hospital)

Correspondence to:
Correspondence to:
Dr D McCrea
Postgraduate Medical Centre, Central Middlesex Hospital, Acton Lane, Park Royal, London NW10 4NS, UK; Daniel.McCrea{at}nwlh.nhs.uk

Objective: The primary role of the patient bedside observation chart is to make clinicians aware of the deteriorating patient. Despite this, its performance has not been scrutinised. Many versions exist with different styles of data entry but the optimal format remains elusive. This paper hypothesised that chart design measurably influences function and that redesign and standardisation would improve the detection of physiological decline by clinical staff.

Design: Objective evaluation of existing charts (n = 5), evidence based redesign, and re-evaluation of new chart.

Setting: 250 bed district general hospital.

Results: Design of existing observation charts had a significant effect on the ability of clinical staff to detect patient deterioration, with detection rates of parameters indicating physiological decline ranging from 0% to 100%. Graphical plots portrayed information better than written values for all parameters being measured except tachypnoea. No single existing chart was best for all variables. A new chart was designed, implemented with training in its use, and re-evaluated. The new chart also incorporated an early warning scoring system. There were significant improvements in the average detection rates of parameters poorly identified on existing charts: detection rates of tachypnoea and hypoxia increased by 41% (p<0.05) and 45% (p<0.05) respectively. There were also significant improvements in detection rates of tachycardia and fever by 29% (p<0.05) and 16% (p<0.05) respectively.

Conclusion: Evidence based redesign of the patient bedside observation chart coupled with specific training in its use significantly improves the detection of patient physiological deterioration.

Keywords: observation chart; evidence based medicine