Exploring Vital Sign Data Quality in Electronic Health Records with Focus on Emergency Care Warning Scores
06 May 2017
03 July 2017
20 December 2017 (online)
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
KeywordsVital signs - data quality - emergency medicine - electronic health records - clinical decision support systems.
The study was approved by the Stockholm region ethical committee (Dnr 2014/1207–31/4) and performed with anonymized data.
Human subjects’ protection
As the data was anonymized and retrieved retrospectively no consent was obtained. Using anonymized data protected the integrity of the participants.
Availability of data and material
All data generated or analysed during this study are included in this published article [supplementary file 1].
All authors contributed to the work in a way that fulfils all of the four ICMJE criteria for authorship, including reading and approving the final manuscript. NS was the project leader, coordinated the study and was involved equally in all parts. RC contributed to the analysis of the results, drafting and reviewing of the manuscript. HB supported the work by feedback on results and analysis and critically reviewing of the manuscript. SK acted as project owner of the study contributing with scientific methods, drafting and reviewing of the manuscript.
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