Flash Mob Research: A Single-Day, Multicenter, Resident-Directed Study of Respiratory Rate

doi:10.1378/chest.12-1837

Chest

Volume 143, Issue 6, June 2013, Pages 1740-1744

https://doi.org/10.1378/chest.12-1837 Get rights and content

Background

Vital signs are critical data in the care of hospitalized patients, but the accuracy with which respiratory rates are recorded in this population remains uncertain. We used a novel flash mob research approach to evaluate the accuracy of recorded respiratory rates in inpatients.

Methods

This was a single-day, resident-led, prospective observational study of recorded vs directly observed vital signs in nonventilated patients not in the ICU on internal medicine teaching services at six large tertiary-care centers across the United States.

Results

Among the 368 inpatients included, the median respiratory rate was 16 breaths/min for the directly observed values and 18 breaths/min for the recorded values, with a median difference of 2 breaths/min (P < .001). Respiratory rates of 18 or 20 breaths/min accounted for 71.8% (95% CI, 67.1%-76.4%) of the recorded values compared with 13.0% (95% CI, 9.5%-16.5%) of the directly observed measurements. For individual patients, there was less agreement between the recorded and the directly observed respiratory rate compared with pulse rate.

Conclusions

Among hospitalized patients across the United States, recorded respiratory rates are higher than directly observed measurements and are significantly more likely to be 18 or 20 breaths/min.

Section snippets

Study Design

This was a single-day, multiinstitution, observational study. Internal medicine chief residents from six academic centers established a collaborative network that obtained institutional review board approval at each center, developed a research protocol, and engaged and trained residents in the conduct of this large-scale clinical study. Data were collected on any internal medicine (general or subspecialty service) patient who was primarily managed by resident physicians (teaching service).

Results

Vital sign measurements were collected from 368 patients from the six participating centers. The median respiratory rate was 16 breaths/min (IQR, 14-20 breaths/min) for directly observed measurements and 18 breaths/min (IQR, 18-20 breaths/min) for recorded measurements, with a median difference of 2 breaths/min (P < .001). Of the 361 sets of vital signs with both recorded and directly observed respiratory rate data, 71.8% (95% CI, 67.1%-76.4%) of the recorded values were 18 or 20 breaths/min

Discussion

Although skepticism regarding the accuracy of respiratory rate measurement is not new, this study represents, to our knowledge, the first prospective, multicenter examination of recorded respiratory rates in hospitalized patients, and it was accomplished using a novel flash mob research methodology.9., 11., 12. Anticipating that the manual measurement required to assess respiratory rate introduces a bias not shared by the automatically measured vital signs, we investigated the hypothesis that

Acknowledgments

Author contributions: Drs Semler and Stover had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Semler: contributed to the study concept and design; data acquisition, analysis, and interpretation; statistical analysis; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.

Dr Stover: contributed to the study concept and design; data acquisition, analysis,

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Drs Semler and Stover contributed equally to this work.

Funding/Support: This work was supported by the National Heart, Lung and Blood Institute, National Institutes of Health [HL105869] to Dr Rice.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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Chest

Original ResearchSigns and Symptoms of Chest DiseasesFlash Mob Research: A Single-Day, Multicenter, Resident-Directed Study of Respiratory Rate

Background

Methods

Results

Conclusions

Section snippets

Study Design

Results

Discussion

Acknowledgments

Chest

Chest

J Crit Care

Resuscitation

Chest

Ann Emerg Med

Resuscitation

J Biomed Inform

Br J Anaesth

Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients

J Gen Intern Med

Original Research
Signs and Symptoms of Chest Diseases
Flash Mob Research: A Single-Day, Multicenter, Resident-Directed Study of Respiratory Rate