Background: Serious Adverse Events in hospitalized patients, such as unanticipated admission to Intensive Care Unit and cardiac arrest, are often preceded by deteriorating vital signs. Early Warning Scores (EWS) are used to allow detection of deterioration. EWS systems is implemented based on the strong association between vital sign abnormalities and poor outcomes shown in several retrospective studies. Only few studies have examined the clinical impact of EWS.
Individual Early Warning Score (I-EWS) is a newly developed track and trigger system where the assessment of vital signs by EWS is combined with a clinical assessment of the patient. This combination has in a previous randomized study improved triage of acutely admitted patients. Prior to comparing I-EWS to the already implemented National Early Warning Score (NEWS) in a prospective cluster-randomized crossover multicenter study, a feasibility study was performed. The aim was to test the use of I-EWS in a clinical setting and to explore the nursing staff’s experience with I-EWS.
Methods: We performed a feasibility study of the implementation of I-EWS. I- EWS is integrated as a mandatory part of the electronic health care journal. Vital signs are registered, and an aggregated score calculated. Nursing staff is asked to revise the score based on their clinical assessment. The score can be adjusted with a maximum of -4 or +6 points or kept unchanged if the score matches the patient’s clinical presentation. We recorded the number of I-EWS scores and the proportion of up- and down adjustments of the scores. A questionnaire was sent electronically to the staff subsequently to assess the level of information about I-EWS and the applicability of I-EWS. As well as to assess the nursing staff’s perception of I-EWS as a track and trigger
system. Data was collected at Herlev and Gentofte Hospital, a 949-b ed University Hospital in the Capital Region of Denmark. Eight medical and surgical wards with a total of 250 beds used the I-EWS for a 2-week period in June 2018. Ambassadors from every ward, participated in an introduction course prior to initiation of the study. The Ambassadors introduced their colleagues to I-EWS.
Results: We recorded 5669 observations during the study period. I-EWS was used in 4585 (80.9 %) of the observations by the end of the second week. Of these scores 876 (19.1 %) were downgraded and 116 (2.6 %) were upgraded.
Eighty-one of the 181 questionnaires (45%) were returned and 65.4% were very satisfied/satisfied with the level of information and 16 % answered neither nor. 80.3 % found the registration of I-EWS easy. Less than 6.7 % found no clinical relevance of I-EWS.
Conclusions: The possibility to adjust EWS was feasible and well received among hospital staff. The effect of I-EWS being tested in an ongoing multicenter study that is ongoing.