Reducing Missed Vital Signs through Structured Hourly Rounding in the ICU

Abstract

Background: Missed or delayed vital sign monitoring is a significant contributor to adverse patient outcomes in critical care settings. Unstructured rounding practices and inconsistent documentation were identified as contributing factors to delayed recognition of patient deterioration in the ICU at Wadi Al-Dawaser General Hospital.
Objectives:

1. To reduce missed vital sign recordings by 50% within three months.


2. To achieve ≥90% compliance with structured hourly rounding protocol.


3. To improve staff accountability and timely response to abnormal vital signs.

Methods: A quality improvement intervention using the FOCUS–PDCA framework was implemented from April to June 2025. All ICU nurses (n=25) participated. Interventions included staff education, introduction of a standardized hourly rounding checklist, and weekly compliance audits. Data were collected using audit tools and analyzed using descriptive statistics.
Results: Missed vital signs reduced from 32 to 5 cases per month (↓84%). Hourly rounding compliance increased from 52% to 88%, and timely documentation of abnormal vital signs improved from 64% to 91%. The project met its performance targets and showed a sustained improvement trend.
Conclusion: Structured hourly rounding effectively reduced missed vital signs and improved documentation compliance and patient safety in the ICU. Continuous auditing, staff engagement, and managerial support are key to sustaining results.