Medical Education 1987, 21, 277

Correspondence

Divergent views of hospital staff in detecting hypertension in a district general hospital

Dear Sir We have recently completed a survey on atti- tudes of hospital staff on detecting hyperten- sion. T w o similar surveys have been published previously (Taylor et al. 1979; Manek et a l . 1984) both from teaching centres. We set out to establish the views of staff working in a district general hospital setting, by questioning 3 878 staff (316 medical and 3562 nursing) in 11

hospitals in the Hull area, catering for every specialty except mental handicap. A total of 1082 replies were received: 97 replies from doctors and 985 from nurses including IOO

from student and pupil nurses. The response rate was low (27%) due to the difficulties inherent in conducting a large survey in geo- graphically separated hospitals.

Our results revealed that only 26 doctors (27%) were taught to use phase V and 43 (44%) were doing so at the time of the study. A total of 533 nurses (54%) were taught to use phase V and 535 (54%) were doing so. Forty- five pupil and student nurses had been taught to use phase V. We also asked whether staff assessed systolic blood pressure by palpation prior to auscultation: 56 doctors (58%) and 506 nurses (51%) did so. Lastly we asked whether staff measured blood pressure to the nearest 5 , 2 or I m m of mercury. Seventy doctors (72%) read to the nearest g m m and 22 (22%) to the nearest 2 mm. A total of 388 nurses (39%) read to the nearest smm, 404 (41%) to the nearest z m m and 193 (zoo/,) to the nearest I mm.

We conclude that the diastolic dilemma per- sists at the district general hospital as it does in the teaching centres and that further errors in measuring systolic blood pressure may occur as palpation prior to auscultation is not universal- ly practised and there is a considerable variation concerning at which level staff consciously choose to read blood pressures,

If blood pressure measurement is to become increasingly routine, the standards of accurate measurement should be high. Rounding-off, failure to use palpation prior to auscultation, the inconsistent use of phase IV or V, uncon- scious digit preference and conscious avoidance of blood pressure values associated with thera- peutic decisions all lead to inaccurate measure- ment. Silman (1985) noted an unacceptable de- gree of observer bias even with committed observers using a reputable random zero sphygmomanometer. While Hosie & Hosie (1985) suggested retraining staff, we believe that this would be a huge task as about half our doctors were rounding off, using phase IV and did not use palpation.

Perhaps conformity in blood-pressure measurement will only be reached when obser- ver error is eliminated altogether by the use of accurate, well-maintained electronic sphygmo- manometers. Until then we should concentrate on teaching future doctors and nurses to per- form a basic part of the clinical examination in an accurate and uniform way.

References Hosie G.A.C. & Hosie J. ( ~ 9 8 5 ) ‘Failure’ of random

zero sphygmomanometer in general practice. Brit- irh MedicalJoumal 291, 137.

Manek S . , Rutherford J., Jackson S. & Turner P. (1984) Persistence of divergent views of hospital staff in detecting and managing hypertension. British MedicalJournal289, 1433-4.

Silman A.J. (1985) Failure of random zero sphygmo- manometer in general practice. British Medical Journal 290, 178 I .

Taylor L., Foster M.C. & Beevers D.G. (1979) Divergent views of hospital staff on detecting and managing hypertension. British Medical Journal i, 715-6.

J. Cox & G. BUCKTON Department of Medicinefor the

Elderly, North Hunzberside, Kitigston Gerieral Hospital,

Beverley Road, Hull HU3 IUR,

England

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