Authors: (including presenting author): :
Lau K.Y. (1), Chan C(1), Cheung P.C. (1), Lee C.H.(1)
Affiliation: :
(1) Urology, Department of Surgery, Princess Margaret Hospital
Keyword 1: :
Vital signs monitoring
Keyword 2: :
Nurse-led intervention
Keyword 3: :
Patient-centered care
Keyword 4: :
Clinical decision-making
Keyword 5: :
Interdisciplinary collaboration
Introduction: :
Vital signs monitoring is fundamental to the early detection of patient deterioration. However, conventional practice often relies on fixed, doctor-prescribed monitoring frequencies that may not reflect patients’ evolving clinical status. This approach can result in over-monitoring of clinically stable patients or suboptimal monitoring of clinically unstable patients, contributing to patient disturbance or delayed recognition of deterioration. Nurses are primarily responsible for patient assessment and, through sustained monitoring, acquire comprehensive understanding of patients’ clinical conditions to support appropriate adjustment of monitoring frequency. VitalSwitch was developed as a nurse-driven approach that empowers nurses to adjust vital signs monitoring frequency using structured guiding principles. Within this framework, VitalSwitch allows nurses to decrease (Down) or increase (Up) vital signs monitoring frequency according to patients’ clinical status, guided by defined criteria and interdisciplinary communication.
Objectives: :
1. To improve quality of patient care. 2. To enhance communication among doctors and nurses.
Methodology: :
A nurse-driven vital signs optimization system, VitalSwitch, was piloted in a surgical ward (P6) from 14 May 2025 to 22 June 2025. The P6 ward is the only dedicated urology ward in a major public acute district general hospital with wide-spectrum, managing a wide range of urological patients with varying urological complexity, age groups, and comorbidity. Evidence-based guiding principles were collaboratively developed by nurses and doctors, incorporating Modified Early Warning Score (MEWS), clinical stability, urine output, laboratory results, and interdisciplinary communication. Quantitative evaluation included retrospective review of patient records to assess compliance, safety outcomes, and diagnostic performance of the guiding principles. A golden test was performed to determine the sensitivity and specificity of the guiding principles. The gold standard was defined as documented clinical deterioration within 24 hours requiring medical assessment, clinical intervention, escalation of care, or the occurrence of adverse events. Qualitative evaluation was conducted using questionnaires for nurses, doctors, and patient care assistants (PCAs) with a 6-point Likert scale.
Result & Outcome: :
88 patients underwent 100 actual VitalSwitch episodes, including 19 episodes of VitalSwitch Up and 81 episodes of VitalSwitch Down. Compliance with VitalSwitch was 75.5%, and documentation compliance reached 98%. A total of 309 unnecessary vital signs measurements were avoided, saving an estimated 25.75 nursing hours. No adverse events or delayed interventions were identified among patients who underwent VitalSwitch Down. VitalSwitch demonstrated a sensitivity of 33% and a specificity of 95% in identifying truly stable patients suitable for reduced monitoring by using golden test. This reflected only patients with clear clinical stability were selected for step-down (33% sensitivity), with strong protection against unsafe de-escalation (95% specificity). Staff reported improved communication between nurses and doctors, enhanced clinical decision-making, and more efficient use of nursing time. Strong support for continuation of the program was expressed across all staff groups, including doctors, nurses, and patient care assistants. VitalSwitch effectively reduced unnecessary vital signs monitoring while maintaining patient safety and improving interdisciplinary communication. The nurse-driven, patient-centered approach enhanced clinical confidence and care efficiency, supporting sustainable implementation in ward and further refinement for wider adoption.
