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Just to add a perspective from across the pond, in United States hospitals doctors tend to write 'vital signs stable' instead of 'observations stable'. I believe these are completely equivalent statements that refer to the same set of nursing findings. I also have found that this statement, many times abbreviated as VSS is less than useful. One finds that in many patients whose progress notes record VVS, in fact, the vital signs are stable - stable and bad. This interest work documents the same problem in the UK along and that at times the observations are not even stable. This problem appears to be worse in my hospital system as we have gone to an electronic medical record in which progress notes are copied and pasted from the previous day (almost always with uncorrected spelling errors). I am considering a follow-up paper from the USA for next year's Christmas issue.
Competing interests:
No competing interests
30 December 2011
R. Hal Scofield
physician, medical resercher
University of Oklahoma Health Science Center, Oklahoma Medical Research Foundation, Department of Veterans Affairs Medical Center
The thought-provoking study of Scott et al suggests to me a decline in standards in the last decade. In my house officer days, “Obs stable” would not suffice; we employed the far more comprehensive, if tautological, “Obs stable. Afebrile.” Thus the reader (usually the same doctor the next day) would be assured that, of all the “obs” deemed stable, temperature in particular was not high. On a more serious note, Table 1 of their study shows that temperature was least likely to have been abnormal in the 24 hours preceding an “Obs stable” statement, suggesting perhaps that we do privilege temperature when assessing the observation chart. This may make physiological sense at times, and the temperature reading may be likely to be the most reliable of the obs, but it can lead to missing important signs (for example of sepsis in the elderly), and so one take home message might be, “Don’t just look at the temperature!”
Competing interests:
No competing interests
28 December 2011
Omar Mahroo
Academic Clinical Lecturer
King's College London
St Thomas' Hospital Campus, Westminster Bridge Rd, London SE1 7EH
Re: Relevance of the expression “obs stable” in nursing observations: retrospective study
Just to add a perspective from across the pond, in United States hospitals doctors tend to write 'vital signs stable' instead of 'observations stable'. I believe these are completely equivalent statements that refer to the same set of nursing findings. I also have found that this statement, many times abbreviated as VSS is less than useful. One finds that in many patients whose progress notes record VVS, in fact, the vital signs are stable - stable and bad. This interest work documents the same problem in the UK along and that at times the observations are not even stable. This problem appears to be worse in my hospital system as we have gone to an electronic medical record in which progress notes are copied and pasted from the previous day (almost always with uncorrected spelling errors). I am considering a follow-up paper from the USA for next year's Christmas issue.
Competing interests: No competing interests