Early Warning Score Improves Patient’s Prognosis

Most in-hospital adverse events, such as heart failures, emergency transfers from inpatient wards to intensive care units and unexpected deaths, are not sudden events [1]. Up to 80% of in-hospital adverse events are preceded by hours of critical disorders of the basic vital functions [2].

These functional disorders are revealed by changes in physiological measured values of pulse, blood pressure, temperature, respiratory rate, etc.

Most adverse events could be prevented if the patient vital signs were monitored and any changes in them were met with a timely response [2].

Early Warning Score (EWS) was developed for this purpose and it was based on the principle that clinical deterioration can be observed through changes in the physiological measured values. The measured values are scored according to how much they deviate from normal ones. The total score indicates the patient’s risk class (low, medium or high), for which the hospital determines corresponding clinical measures, such as alerting the medical team.

Starting Adequate Care in Time

EWS is a simple and easy nursing tool, which helps identify patients whose condition is deteriorating acutely. In combination with available care, EWS can be used to begin adequate care immediately after detection, which can have a positive effect on the clinical results.

Utilising EWS scoring in the area of nursing also reduces hospital costs. The early detection of the patient’s deteriorating condition reduces the factor that most commonly raises costs, namely the number of transfers to intensive care. When the patient’s care can be started earlier, hospital stays are more likely to shorten as well.

Furthermore, research [3] has shown that timely detection of critical vital sign changes reduces the hospital mortality rate.

The seriousness of a disease in itself cannot be influenced, but care quality and any delay in the commencement of adequate care are things that can be influenced.

Change of Procedure Demanding Cooperation

Various occupational groups should be up to date on the EWS practices of the hospital. Everyone should know what is involved with EWS scores: calls to the unit’s own doctor concerning these and alerts to get the Medical Emergency Team (MET) to intensive care. Information should therefore reach both doctors and nurses and , in order to reach a consensus, the operating guidelines should be as clear as possible. Above all, this is a question of cooperation, which will seem to increase the number of duties at first.

When EWS scores have to be calculated several times a day, it does take up extra care time. In addition, nurses should have a pen, paper and an EWS score card with physiological parameters and threshold values that determine ranges for those parameters. Then the total score is calculated. However, any quick mental calculation may cause documentation errors. Despite all this, the benefits are greater than the harm.

Improve the Process with Technology

Nevertheless, this is a good example of a situation where technology can be utilised to facilitate nursing. With the help of technology, the score calculation can be automated and instructions for action being displayed to the care staff immediately, whereby human errors are minimised and patient safety improves. Technology also makes it possible to have this data on the patient’s condition up to date and available to everyone participating in the care.

For proactive patient care, however, it is essential that the basic vital functions are evaluated and not merely measured.

So, it is not enough to record the patient’s vital signs, but to also know how to evaluate them systematically. The response to the vital signs is based on this evaluation in accordance with the agreed practices of the hospital. Thus, the best possible patient care can be made possible.


[1] Tirkkonen 2015: Detecting and Reacting to In-hospital Patient Deterioration Studies on the afferent and efferent limbs of the Rapid Response System

[2] Berlot et al. 2004: Anticipating events of in-hospital cardiac arrest

[3] Schmidt et al. 2014: Impact of introducing an electronic physiological surveillance system on hospital mortality


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