Screening using the fifth vital sign in the electronic medical recording system

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Purpose</div>To investigate the usefulness of screening for patient symptoms as the fifth vital sign using an electronic medical recording system.<div class="boxTitle">Patients and methods</div>In the electronic medical recording system, all admitted patients received routine nurse-based assessment of discomfort (defined as any physical symptom) at every vital sign check regarding item 2 of the Support Team Assessment Schedule Japanese version (STAS-J). All cancer patients admitted to oncology units were screened at 1-week intervals. Screening-positive was defined when patients had a STAS-J score of 2 or more at least two times in a week. For all screening-positive patients, the palliative care team reviewed each patient's medical records, and provided written recommendations as needed. The primary outcomes were the proportion of screening-positive patient, and the proportion of patients deemed to need additional palliative treatment in the screening-positive patients.<div class="boxTitle">Results</div>Of 2427 patients screened, 223 (9.1%; 95% confidence interval, 8–10%) met the screening-positive criterion. A total of 12 (5.4%; 95% confidence interval, 3–9%) of them were deemed to need additional palliative care, including six patients referred to the PCT within 1 week. In the remaining 211 screening-positive patients, 100 had received adequate palliative care, 68 had already been referred to the palliative care team and 43 had self-limiting transient discomfort.<div class="boxTitle">Conclusion</div>This screening system was feasible but the majority of screening-positive patients did not require additional palliative care interventions.</span>

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