I was recently engaged in a Twitter discussion regarding the necessity of taking “vital” signs in our patients. I want to highlight several reasons why we should be taking, and monitoring basic vitals (HR, BP) in each of our patients.
1. It has been developed as a Standard of Care. Taking vital signs is an essential component of every new patient exam as documented in the Guide to Physical Therapist Practice. From a legal standpoint, the Guide establishes a standard of care for all physical therapists and physical therapist assistants, and in any case of incident, if you can not demonstrate that you were following a Standard of Care, you increase your legal liability. The APTA has provided several resources on this topic here.
2. Assessing vitals at baseline only, does not give us enough information. I suspect we need to screen vitals in each of our patients, on each of their visits. This can be performed easily by a PT or PTA, and the values can be used in determining a progression of care, or necessity of referral. The APTA has provided in its resources to Physical Therapists: Heart-Health Screenings, as published by the AHA. The AHA’s recommendations for BP are as follows: If an individual is 20 years or older, blood pressure should be assessed at every healthcare visit (notice the terminology; not “medical” visit) or at least every 2 years if blood pressure is less than 120/80mmHg. Again, when we look at Standard of Care, for legal defensibility, the APTA has provided this resource for Physical Therapists. We better take note.
3. Patients who seek are care in outpatient facilities, may have underlying pathology . A 4-year retrospective analysis of 14,970 participants, found that younger participants received a diagnosis of hypertension slower than older counter-parts. Early detection of heart-disease is key in it’s management and simply suspecting the patient does not have underlying pathology, when they may, is very poor professional practice. Just remember: we have no way for determining if a patient has high blood pressure, without truly measuring it. Don’t “suspect” a patient has “good” vitals, without truly checking.
4. To be recognized as Direct Access providers, we must accept responsibility for that individuals well-being. As we move towards a practice of increased autonomy, we also move towards a practice of increased liability. We can no longer fall back upon the idea, “the physician should have caught that…”. We need to accept responsibility for our patients health. At a minimum, we are responsible for screening for any potential pathology that may necessitate a referral.