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Improving Respiratory Rate Accuracy in the Hospital: A Quality Improvement Initiative
Author(s) -
Keshvani Neil,
Berger Kimberly,
Gupta Arjun,
DePaola Sheila,
Nguyen Oanh Kieu,
Makam Anil N
Publication year - 2019
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3232
Subject(s) - medicine , interquartile range , tachypnea , vital signs , emergency medicine , relative risk , concomitant , intensive care medicine , confidence interval , anesthesia , tachycardia
Respiratory rate (RR) is a predictor of adverse outcomes. However, RRs are inaccurately measured in the hospital. We conducted a quality improvement (QI) initiative using plan‐do‐study‐act methodology on one inpatient unit of a safety‐net hospital to improve RR accuracy. We added time‐keeping devices to vital sign carts and retrained patient‐care assistants on a newly modified workflow that included concomitant RR measurement during automated blood pressure measurement. The median RR was 18 (interquartile range [IQR] 18‐20) preintervention versus 14 (IQR 15‐20) postintervention. RR accuracy, defined as ±2 breaths of gold‐standard measurements, increased from 36% preintervention to 58% postintervention ( P < .01). The median time for vital signs decreased from 2:36 minutes (IQR, 2:04‐3:20) to 1:55 minutes (IQR, 1:40‐2:22; P < .01). The intervention was associated with a 7.8% reduced incidence of tachypnea‐specific systemic inflammatory response syndrome (SIRS = 2 points with RR > 20; 95% CI, –13.5% to –2.2%). Our interdisciplinary, low‐cost, low‐tech QI initiative improved the accuracy and efficiency of RR measurement.