<p>Background A&amp;E department records were collected over a four-week period for all patients admitted to hospital via A&amp;E. Timing and values of recorded observations were collected, as was the length of time spent in the department.</p> <p>During the study period, 739 patients were admitted. Observation charts were available for 728. Those having some observations within 15 minutes of arrival totalled 640 (88 per cent); 378 (52 per cent) had temperature, heart rate, respiratory rate and blood pressure recorded; and 265 (36 per cent) had repeat observations while waiting for admission. The mean time in the department was three hours 43 minutes.</p> <p>Conclusion Recorded patient observations are carried out in an inconsistent pattern in this A&amp;E department and standards should be set. Patients at risk of deterioration must be identified early. Complete observations should be carried out so that patients with abnormal physiology can be prioritised for treatment and repeated observation can be instituted to monitor response to interventions.</p> <p>Further work is needed to determine variables that provide the best prediction of outcome and whether increasing observation frequency and earlier activation improves outcome.</p>