Tuesday, March 14, 2017

Numbers: They Don't Mean Much

I’m a firm believer that numbers mean very little when it comes to the care of patients.

When ICU patients or their family members would ask me what number is “good” for a specific vital sign on the bedside monitor, I always told them that the numbers don’t mean much.

They’d almost always respond something like “but I see you looking at the numbers.”

Then I had to explain that they see me looking at the number but they don’t see the other assessments I have done and the decisions that I’ve made about the patient in addition to looking at the numbers.  

The condition of the patient, the trends in vital signs, how the patient is responding, what else is going on, etc., are important.  The individual numbers are not very useful.  

Unfortunately, we’ve gotten in to a situation with numbers when it comes to treating pain.   We ask the patient to rate their pain and then we medicate the patient based on the number.  

We know that it may be necessary to treat some patients with a Hgb of 7.4 with a transfusion and it may be perfectly acceptable to not transfuse another patient with the same Hgb.  It’s the same with blood pressure.  A patient who is awake, alert, and making urine with a blood pressure of 80/50 may not need intervention and another patient with the same blood pressure may need fluids and/or vasopressors.  

We need to get to that point with the pain scale.  Removing the pain scale as the 5th vital sign is not necessarily the answer.  The answer is to assess and treat or not treat more than just that number.

Treating numbers is never a good idea.

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