CLINICAL SCHOLARSHIP

Exploring the Frequency of Blood Pressure Documentation

in Emergency Departments
Rebecca S. Miltner, PhD, RN, CNL, NEA-BC1 , Kimberly D. Johnson, PhD, RN, CEN2 , & Rhiannon Deierhoi, MPH3
1 Assistant Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, AL and Birmingham VA Medical Center, Birmingham, AL
2 Assistant Professor, College of Nursing, University of Cincinnati, Cincinnati, OH
3 Department of GI Surgery, University of Alabama at Birmingham, AL and Birmingham VA Medical Center, Birmingham, AL

Key words Abstract

Vital sign monitoring, emergency department,
Emergency Severity Index (ESI), documentation
Correspondence
Dr. Rebecca S. Miltner, 1449 Haddon Place,
Hoover, AL 35226.
E-mail: smiltner@uab.edu
Accepted: October 28, 2013
doi: 10.1111/jnu.12060
Purpose: One of the most commonly performed task in the emergency de-
partment (ED) is reported as the monitoring of vital signs, yet there are no
published standards of care that provide guidelines for the frequency of ob-
taining vital signs in the ED. The purpose of this exploratory study was to
determine the frequency of documentation of vital signs recorded during ED
visits across Veterans Health Administration (VHA) facilities.
Methods: Deidentified patient level data from the VHA electronic health
record (EHR) were abstracted for emergency department visits for 12 ran-
domly selected days in calendar year 2011. The dataset included vital signs
data, associated time stamps, facility, length of stay, triage category based on
the Emergency Severity Index (ESI), and patient disposition for all patients.
Descriptive statistics were used to describe the frequency of the specific vital
sign measures, and parametric and nonparametric tests were used to examine
study variables by ESI.
Findings: The sample consisted of over 43,232 unique patient visits to 94
VHA EDs with a median length of stay of 173.3 min (interquartile range [IQR],
96.1–286.9). The mean number of times that blood pressure (BP) was recorded
per visit was 1.23 (SD 1.175). For the entire sample, median time between
blood pressure measurements was 139.7 min (IQR, 81.6–230.1). There was a
significant difference in median length of stay and median time between blood
pressure by ESI category.
Conclusions: In this dataset, median time between documentation of BP in
the ED was every 2.3 hr for all patients. While the median time was statistically
significant between ESI categories, these times may not be clinically relevant.
More important was the inconsistent documentation of vital signs of ED pa-
tients in the designated fields in the EHR. Most facilities (84.1%) documented
BP for >75% of patient visits. However, eight facilities (9.1%) had BP docu-
mented in <50% of patient visits.
Clinical Relevance: It seems unlikely that vital signs are not monitored in the
ED; nurses anecdotally report that vital signs are recorded on a paper chart and
later scanned as an image into the EHR. However, lack of consistent process in
documentation of vital signs may decrease the care team’s ability to note early
warning signs of physiological instability or deterioration.

98 Journal of Nursing Scholarship, 2014; 46:2, 98–105.

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Miltner et al.
Vital signs (heart rate [HR], respiratory rate, tempera-
ture, blood pressure [BP], peripheral oxygenation, and
pain) are simple measurements of physiological param-
eters that represent a set of objective data used to de-
termine general parameters of a patient’s health and
viability. These values influence the doctors’ and nurses’
interpretation of a patient’s overall condition and affect
the course of treatment for each patient individually.
Historically, vital signs have been considered an integral
part of the nursing assessment and are often used as a
decision-making tool (Gilboy, Travers, & Wuerz, 2000). It
is possible that vital sign frequency can affect outcomes by
preventing death, providing patient–staff interaction, and
supporting perception of competency, all activities with
potential links to satisfaction with care quality. However,
this has not been validated in the literature. Vital sign
monitoring also may stand in as a marker of frequency
of direct observation of patients to better evaluate patient
condition changes or patient responses to interventions.
The frequency of obtaining vital signs depends on hospital
and unit level policies, physician orders based on the pa-
tient’s chief complaint and acuity level, and nursing judg-
ment about the priorities for patient care.
A commonly performed task in the emergency depart-
ment (ED) is the monitoring of vital signs (Hobgood,
Villani, & Quattlebaum, 2005). Vital signs are recorded at
least once on every ED patient and are monitored because
changes can herald an imminent adverse change in the
patient’s condition (Lighthall, Markar, & Hsiung, 2009).
Vital signs are often used as an early warning system for
physiological instability or deterioration (Holcomb et al.,
2005; Tarassenko, Hann, & Young, 2006). Although the
assessment of vital signs is a common task for an ED
nurse, there is limited information regarding the optimal
frequency with which vital signs should be monitored.
The majority of the literature addressing the frequency of
vital sign monitoring is focused on hospitalized patients
and is inconsistent in nature.
Guidelines for the frequency of vital signs focus on the
care of stroke or cardiac patients (Broderick et al., 2007).
There are no published standards for vital sign monitor-
ing for ED patients, so policies may be established at the
local level. There are few studies that have examined the
frequency of vital signs in the ED for nontrauma patients.
Studies that focused exclusively on trauma patients that
were not included as protocols for the care of these pa-
tients include continuous physiologic monitoring, which
is not routine for other ED patients.
In a perioperative area, Zeitz and McCutcheon (2006)
conducted a retrospective review of 144 patient medical
records to determine if the frequent collection of rou-
tine postoperative vital signs had an impact on the detec-
tion of patient complications in one Australian hospital.
Journal of Nursing Scholarship, 2014; 46:2, 98–105.
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Frequency of Blood Pressure Documentation
When a complication was detected, the chart documen-
tation was reviewed to identify what changes occurred in
the patient and the processes that were used to detect the
change. Several measures correlated with patient compli-
cations. Increased pulse had a weak correlation with the
incidence of non–life-threatening clinical events requir-
ing intervention (r = .31, p < .05) and nausea (r = .49,
p < .05), while a lowered HR strongly correlated with
vomiting (r = .63, p < .05). Unfortunately, the authors
did not report if the nurse adherence to the policy of
the frequency of postoperative vital signs was observed
or had an impact on the preemptive treatment of clinical
events or complications experienced by the patients.
Mariani et al. (2006) evaluated the benefits from rou-
tine vital signs evaluated every 6 hr versus every 8 hr or
longer in 147 community-acquired pneumonia patients
admitted to the hospital between November 2000 and
September 2001. Fifty-six (39%) of the patients had vi-
tal signs recorded less often than every 8 to 12 hr, while
87 (60.8%) had vital signs recorded every 4 to 6 hr. Af-
ter adjusting for demographics and comorbidities, the re-
searchers reported that frequent vital sign evaluation did
not result in a significant difference in survival, transfers
to the intensive care unit, or length of stay (LOS). They
suggested that frequent vital signs are generally unnec-
essary and not cost effective in this patient population.
Unfortunately, this brief report did not include analytical
information to support their conclusions. Nor was it clear
if specific protocols for frequency were followed or if in-
terventions were performed when abnormal vital signs
were identified.
Only two studies could be located that examined the
frequency with which vital signs are recorded in the
ED (Armstrong, Walthall, Clancy, Mullee, & Simpson,
2008; Johnson, Winkelman, Burant, Dolansky, & Totten,
2012). In the United Kingdom, Armstrong et al. (2008)
performed a retrospective review of ED clinical records
to explore factors that influence the recording of vital
signs within the first 15 min a patient is in the ED and
again within 60 min of arrival. This study used a four-
tiered triage system, the Manchester Triage Categories,
which predicts admission and mortality at similar levels
to the Emergency Severity Index (ESI; van der Wulp,
Schrijvers, & van Stel, 2009). Of the 387 charts reviewed,
only 233 (58%) and 29 (7%) had a complete set of vital
signs collected within 15 min and 60 min, respectively.
A significant relationship was identified between Manch-
ester Triage Categories and a failure to record respiratory
rate (OR = .20; 95% CI = .07–.55), oxygen saturation
(OR = .22; 95% CI = .08–.65), HR (OR = .19; 95%
CI = .07–.58), and BP (OR = .18; 95% CI = .06–.54).
The reported rate of recorded vital signs at 60 min may
be related to the study design. The study only included
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Frequency of Blood Pressure Documentation
ED clinical records, not the final records for admitted pa-
tients. Additional vital signs may have been taken within
the first hour but recorded on the inpatient record, and
therefore not included in these analyses.
In the United States, Johnson et al. (2012) conducted
a retrospective chart review of 202 patients to determine
the factors that affect the frequency of vital signs in the
ED. While exploring these factors, they determined that
the average time between vital sign recordings was 130.8
min (interquartile range [IQR], 4–807). However, this
study was limited by its reliance on the handwritten no-
tations of the ED staff. Additionally, this study excluded
low-acuity patients with assigned ESI scores of 4 and 5.
Armstrong et al. (2008) and Johnson et al. (2012) ex-
amined the frequency of vital signs in the ED, but from
different perspectives. Johnson et al. (2012) looked at the
repetition of vital signs over the patients’ entire ED stay,
while Armstrong et al. (2008) only examined vital signs
in the first hour of the episode of care. Both studies re-
ported that vital signs were not consistently repeated as
often as the researchers expected. Because each of these
studies focused on a single ED, it is not known if these
findings are generalizable to other EDs or if there is clin-
ical significance that vital signs are not recorded as fre-
quently as expected.
No literature was located that examined the relation-
ship of vital sign monitoring and patient outcomes in the
ED. While no national or international standards of care
are available to provide guidance for the frequency of ob-
taining vital signs in the ED, implicit standards for the
frequency of vital signs may be evident in a large clini-
cal database within the Veterans Health Administration
(VHA) electronic health records (EHRs). The initial pur-
pose of this exploratory study was to determine the fre-
quency that BP is recorded in the EDs in VHA facilities
across the United States and explore the relationship be-
tween vital sign frequency and patient acuity as measured
by the ESI.
Methods
Definitions
Emergency severity index. The ESI (version 4),
used to assign triage category, is the most common triage
system used in the United States and is endorsed by
the Emergency Nurses Association and the Association of
American College of Emergency Physicians. The ESI has
five levels to which patients can be categorized. Level 1
indicates the most urgent category of patients. Patients
in triage level 1 require immediate care because death is
imminent (e.g., cardiac arrest, severe respiratory distress,
unresponsive critically injured trauma patient, anaphy-
100
Miltner et al.
lactic reaction). Patients are classified as level 2 if they are
(a) in a high-risk situation; (b) confused, lethargic, or dis-
oriented; or (c) in severe pain or distress (Eitel, Travers,
Rosenau, Gilboy, & Wuerz, 2003). Once it has been de-
termined that the patient does not belong in level 1 or
2, the amount of resources required to diagnose the pa-
tient is assessed. Before a patient is placed into the level
3 category, the triage nurse assesses the patient for vital
signs that are outside of age-acceptable parameters. The
triage nurse may upgrade a patient from level 3 to level 2
because of abnormal vital signs. Three vital signs are used
to sort adult patients: pulse (HR > 104 beats/min), respi-
ratory rate (> 20 breaths/min), and peripheral oxygena-
tion (< 92%). Patients in level 4 (e.g., ankle injury, uri-
nary tract infection) and level 5 (e.g., prescription refills,
poison ivy) indicate the least urgent categories. Patients
in these categories require only one or no additional re-
sources to make a diagnosis, are physically stable, and can
wait several hours to be seen (Gilboy, Tanabe, & Travers,
2005). Patients are categorized by the ED staff, gener-
ally the registered nurse in the triage area. Although this
system does require clinical judgment, the ESI has been
found to be both a valid and reliable instrument for deter-
mining patient acuity and resource use (Fernandes et al.,
2005).
Length of stay. The time for the stay starts with the
arrival time stamp from the EHR. The stay ends when the
patient is discharged (sent home, admitted, transferred,
etc.) from the ED.
Frequency of blood pressure. The frequency of
BP is reported for the subject’s entire LOS in the ED. The
number of times the BP was documented for each sub-
ject was counted. In addition, the total LOS was divided
by the number of times BP was documented to estimate
time between documented BP.
Sample
After approval by the institutional review board at our
VA facility, the VA Informatics and Computing Infras-
tructure (VINCI) was used to extract deidentified patient
level data from the Corporate Data Warehouse (CDW),
which houses data from the electronic health record (the
Veterans Health Information Systems and Technology
Architecture). VINCI is a secure analytical workspace that
is designed to provide regulated data access for research
that can protect personal health information. Available
data include elements from the CDW, which is updated
nightly. The CDW production data include patient demo-
graphics, vital signs, health factors, outpatient encoun-
ters, and other data elements.
Journal of Nursing Scholarship, 2014; 46:2, 98–105.
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Miltner et al. Frequency of Blood Pressure Documentation

The sample consisted of 94 of 98 VHA acute care fa-

Unique ED Visits
cilities with EDs. Vital sign data including temperature,
12 days CY11
pulse, respirations, BP, oxygen saturation, and pain score
N= 73,751
including time stamps for all vital signs were requested
within the VINCI workspace, and the data were obtained
for all individual patients presenting to the ED in one of
12 randomly selected days (3 days in each quarter) in cal- Removed 19,433 with vital signs
pulled from outside the ED
endar year 2011 to provide a representative snapshot of
N=54,318
variations in ED admissions throughout the year. Other
data pulled included facility, LOS in the ED, and ESI.
The initial dataset contained 73,751 unique patient vis-
its. Visits were eliminated if the vital signs were recorded Removed 2,582 multiple
observations of same patients
outside the ED admission and discharge time frame. In
N = 51,736
addition, we limited cases to the first observation per
patient and for visits with lengths of stay > 1 min and
< 24 hr. Finally, to best ensure that these visits reflected
Removed 42 visits with LOS < 1
ED visits, we removed any visits without a recorded ESI.
minute or missing discharge time
The final cohort consisted of 43,232 unique patient visits N = 51,694
(Figure 1).

Removed 1,304 visits with LOS >

Data Analysis 24 hours
Descriptive statistics were used to examine the study N = 50,390
variables. Unadjusted testing for association between fre-
quency of BP and ESI was done using analysis of variance
(ANOVA) and the Kruskal Wallis test, an extension of Removed 5,726 visits from low
the Wilcoxon rank sum test and the appropriate nonpara- acuity facilities
N = 44,664
metric equivalent to the ANOVA. The nonparametric test
was chosen because the distributions of all of the contin-
uous variables of interest were highly skewed. However,
the mean values of frequency of BP were more clinically Removed 1,432 visits with
missing ESI
meaningful, and we thus chose to present the mean and
Final Cohort = 43,232
standard deviation and run both ANOVA and Kruskal
Wallis for this variable. The nonparametric test was used
Figure 1. Data reduction chart.
to examine the association of median time between BP
measurement and ESI. All analyses were completed us-
Table 1. Frequency of Vital Signs Documentation (N = 43,232 visits)
ing SAS version 9.2 (SAS Institute, Inc., Cary, NC, USA).
Blood Pain Peripheral
All data were maintained within the VINCI platform, and No. Pressure Pulse Respirations Temperature score oxygenation
analysis was also completed within that platform per the recorded n (%) n (%) n (%) n (%) n (%) n (%)
VHA policy. 0 6,246 6,231 6,533 7,260 8,221 14,264
(14.4) (14.4) (15.1) (16.8) (19.0) (33.0)
1 28,573 28,883 29,284 31,753 27,225 23,221
(66.1) (66.8) (67.7) (73.4) (63.0) (53.7)
≥2 8,413 8,118 7,415 4,219 7786 5,747
Results (19.5) (18.8) (17.2) (9.8) (18.0) (13.3)

There were over 43,232 unique patient visits to 94 VHA

EDs. Most vital sign parameters were documented in the
designated fields at least once in over 80% of visits, with
the exception of peripheral oxygenation, which was doc-
umented in only 67% of visits (Table 1). Most patients
were rated as ESI 3 (43.3%), indicating a currently stable
condition that required a more in-depth evaluation, or
ESI 4 (35.8%), indicating a less acute condition that re-
quired minimal ED resources (Table 2). The median LOS
across all visits was 173.3 min (IQR, 96.1–286.9). Further
analyses were limited to BP documentation only.
The mean number of times that BP was recorded per
visit was 1.23 (1.175). The median time from admission
to documentation of the first BP was 13 min (IQR, 6–
30). For the entire sample, median time between doc-
umented BP measurements was 139.7 min (IQR, 81.6–
230.1). There was a significant difference in median LOS

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Frequency of Blood Pressure Documentation Miltner et al.

Table 2. Number of Visits, Length of Stay (LOS), and Blood Pressure (BP) Documentation by Emergency Severity Index (ESI)

Visits LOS (min) BPs documented Time (min) to first Time (min) between
ESI n (%) Median (IQR) Mean (SD) BP Median (IQR) BP Median (IQR)

1 179 189.3 1.36 18 147.1

(0.4) (112.7–300.3) (1.248) (8–47) (92.7–236.9)
2 4,185 236.2 1.77 15 158.3
(9.7) (157.3–348.3) (1.802) (7–37) (95.3–249.3)
3 18,720 228.3 1.43 13 167.5
(43.3) (146–341.5) (1.366) (6–31) (104.5–261.9)
4 15,457 126.1 0.97 12 120.9
(35.8) (72.4–210.9) (.613) (6–28) (69.8–198.3)
5 4,694 87.4 0.84 14 89.2
(10.9) (46.6–150.8) (.550) (6–29) (49.4–150.8)
Total 43,232 173.3 1.23 13 139.7
(96.1–286.9) (1.175) (6–30) (81.6–230.1)

Note: IQR = interquartile range.

by ESI category, with patients with an ESI of 2 hav-
ing the longest LOS and those with an ESI of 5 having
the shortest LOS (228.3 min and 87.4 min respectively,
p < .0001). There was a significant difference in median
time between documented BP measurements by ESI. Pa-
tients with an ESI of 3 had the longest time between BP
measurements (167.5 min), while patients with an ESI
of 5 had the shortest time between BP measurements
(89.2 min, p < .0001).
BP was not documented in the designated EHR fields
in 6,246 (14.5%) visits. Most facilities (84.1%) recorded
at least one BP for over 75% of their ED visits, but eight
facilities had documented BP on < 50% of ED visits. By
facility, the percentage of visits with no documented BP
measurements ranged from 1.4% to 81.4%.
Limitations
This study of frequency of vital sign documentation
across the VHA is limited because only data entered into
structured fields in the vital sign templates were available.
Unexpectedly, only 19.5% of patients had more than one
BP recorded during their ED visit. Nurse leaders in differ-
ent VHA facilities anecdotally reported to the researchers
that patients on a continuous monitor may only have vi-
sual assessment of vital signs with limited recording in
the record. They also reported that vital signs in the ED
may be assessed and recorded on a bedside paper flow
sheet, which is later scanned as an image into the EHR.
These scanned data images are not visible in the struc-
tured fields of the EHR and are therefore not included in
the CDW or our dataset.
Another potential limitation to this exploratory study
is the unknown quality of the data. Because this is a
secondary dataset with very limited patient information
available, the accuracy of the ESI score for individual pa-
tients cannot be assessed, and some error is assumed. In
addition, there may be data entry errors as well that are
unaccounted for.
Discussion
Data analyses found a statistically significant difference
in the mean number of times BP was documented and
in the median time between BP documented for all ESI
groups. However, these data do not indicate an implicit
standard of care for vital sign frequency because it is un-
known from this dataset how many times vital signs were
actually assessed for each visit. There was a small num-
ber of patients with BP documented two or more times;
the mean BP frequency is reported instead of the me-
dian because of the lack of variability across ESI levels
(median 1; IQR, 1–1). The documented BP was usually
recorded in the first half hour after admission, which sug-
gests the initial triage BP may be the only one recorded
in the vital sign template. About 10% of the patients in
this sample were evaluated as ESI 1 or 2, and it is ex-
pected that these patients would have frequent or even
continuous vital sign monitoring. Yet these patients also
had few vital signs documented. The ESI 1 (trauma) pa-
tients also had the longest median time to first documen-
tation of BP (18 min; IQR, 8–47 min). It is highly doubtful
this was the first time that BP was assessed in this criti-
cal patient population, but this probably represents the
challenge of recording key information while simultane-
ously providing resuscitative care. These data suggest is-
sues with workflow and the documentation process.
These issues are not unique to the VHA or to EDs
(Cresswell, Worth, & Sheikh, 2012). Electronic records
offer much promise to improve the efficiency and safety

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Miltner et al.
of patient care, although there is little evidence to date
to support this widely accepted notion (Black et al.,
2011; DesRoshes et al., 2010; Jha, 2011). Most EHR
systems offer flexibility in documentation to meet the
unique needs of local facilities and patient populations.
But if an organization does not explicitly identify the
documentation workflow, there will be inconsistency
or workarounds across providers or facilities (Cresswell
et al., 2012; Rogers, Sockolow, Bowles, Hand, & George,
2013). For example, the VHA maintains a comprehensive
national policy about health records, but provides only
general guidance about ED documentation such as docu-
ment “objective data relevant to the presenting problem”
and “assessment of the problem” (Veterans Health Ad-
ministration, 2012, p. 36). The VHA relies on local facili-
ties to further clarify the documentation expectations for
employees. These data suggest limitations in using broad
guidelines. There is variation in the documentation pro-
cess between these local facilities, with some having high
rates of BP documentation and others documenting less
than 50% of the time. The reasons for this difference
were beyond the scope of this project but merit further
investigation.
Other organizations do not have explicit policies and
procedures outlining frequency of assessments, and, un-
fortunately, physician orders may be vaguely written as
routine vital signs or vital signs per unit policy (Mariani
et al., 2006). Furthermore, vital signs are frequently del-
egated to unlicensed personnel who may not always un-
derstand the importance of this common task (Bittner &
Gravlin, 2009; Kalisch, 2006; National Council of State
Boards of Nursing and the American Nurses Association,
2006). Even registered nurses, who have many different
educational backgrounds and work experiences, may not
have optimal clinical judgment about the frequency of
vital sign monitoring and subsequent documentation of
those findings. Explicit policies and procedures outlining
the frequency of vital sign monitoring may be useful to
not only provide guidelines for nursing personnel, but to
also reduce risk for patient harm.
Unclear standards and documentation inconsistency
may impact handoff communication, reimbursement,
and liability issues as well as impose limits on clinical de-
cision support. For example, globally, more organizations
are using vital sign data in tools such as the Modified
Early Warning Score to alert staff to patients with phys-
iological instability who are at risk for impending deteri-
oration (Gozzard & Haraden, 2007; Kyriacos, Jelsma, &
Jordan, 2011). These risk scoring tools include vital sign
data, level of consciousness, and, sometimes, urinary out-
put to signal the need for rapid response team interven-
tions or plan of care changes (Kyriacos et al., 2011). This
type of alert could be automated in the EHR if vital sign
Journal of Nursing Scholarship, 2014; 46:2, 98–105.
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Frequency of Blood Pressure Documentation
information is consistently recorded in designated struc-
tured fields in the record.
Patient level data are important for quality and safety
improvement initiatives and research. The VHA has a
long-standing EHR and has been on the cutting edge of
health information management and technology, but has
identified problems aggravated by documentation incon-
sistency within the record, including requiring additional
chart abstraction work to estimate performance measures
(Francis, 2012). The VHA is aware of these challenges
and is actively working to address the data quality issues
(Francis, 2012).
These data support the need for research about basic
vital sign monitoring and documentation. In a systematic
review of nursing practice to detect patient deterioration,
Odell, Victor, and Oliver (2009) found that nurses relied
on intuitive judgment and used vital signs to confirm the
intuition. There is a paucity of evidence about nurses’
roles and responsibilities in monitoring and recording vi-
tal signs (Rose & Clarke, 2010). Less is known about
whether documenting vital signs in a standardized format
matter to the function of the care process and team com-
munication. While it seems obvious that monitoring and
documenting vital signs in a consistent manner does mat-
ter, this needs more rigorous evaluation. Perhaps most
alarming is that while vital sign assessment and monitor-
ing is a common nursing task, it is rarely included in the
broader discussions of nursing care quality.
We expected that the data would provide insight into
an implicit standard of care regarding monitoring and
documentation of vital signs in ED patients. We also
hoped that these data would provide pilot data for fu-
ture work to examine nursing practices for vital sign fre-
quency related to patient acuity, use of early warning
sign scores, or other surveillance practices. Instead, we
found inconsistency in the process of documentation of
vital signs in an EHR across a large national healthcare
system that limited further analysis. Vital signs are sim-
ple, but important, physiological parameters that guide
care and treatment for individual patients. More research
is needed to understand the variation in the documenta-
tion of this basic assessment activity. In addition, devel-
opment of evidence-based standards of care for vital sign
monitoring may be useful in avoiding potential patient
harm.
Acknowledgments
This article was supported in part by the Veterans Ad-
ministration Nursing Academy, a partnership between
the Birmingham Veterans Administration Medical Cen-
ter and the University of Alabama at Birmingham School
103
Frequency of Blood Pressure Documentation
of Nursing. The content is solely the responsibility of the
authors and does not necessarily represent the views of
the Veterans Health Administration.
Clinical Resources
r Early Warning Signs Scores: http://www.ihi.org/
knowledge/Pages/ImprovementStories/
EarlyWarningSystemsScorecardsThatSaveLives.aspx
r Emergency Severity Index: http://www.ahrq.gov/
professionals/systems/hospital/esi/esi1.html
r VA Informatics and Computing Infrastruc-
ture (VINCI): www.hsrd.research.va.gov/for
researchers/vinci
r VHA Electronic Health Record: http://www.
ehealth.va.gov/VistA.asp
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