Physician's orders, use of nursing resources, and subsequent clinical events

Orders written by medical residents to be carried out on newly hospitalized patients were reviewed to determine the frequency of vital signs orders. Subsequent clinical events requiring the nurse to contact the house officer were then determined by daily follow-up. No relationship was found between the frequency of initial vital signs and the probability of a subsequent vital-sign event. However, the probability of a subsequent non-vital-sign event was 3.8 times greater among patients with frequent initial vital signs than among all others. Since orders requesting the frequent determination of vital signs appear to predict clinical events other than vital-signs events, such orders may be wasteful of nursing resources. In addition, other skilled observations may be neglected. These data suggest that physicians should request nurses to use more efficient and appropriate methods of clinical observation.