Identifying high-risk patients in emergency care

Harmonious metrics are one of the cornerstones of patient safety in emergency care. The most important thing is to identify high-risk patients so that their proper care can be started as early as possible.

Overcrowding in Emergency Departments (EDs) is a phenomenon that is now widespread globally and there have been several reports of compromised patient safety. Congestion in emergency services is a fundamental problem that we cannot solve easily. However, we see look at the situation from the point of view of preventing patient safety risks: What is the fastest way to identify high-risk patients at Emergency Departments?

Efficient triage and minimising errors

Emergency care providers use triage daily to prioritise the care of acutely ill patients. There are many different triage models used worldwide. The models harmonise the assessment of patients’ need for care and speed up the forwarding of patients to appropriate further care. Triage guidelines should be harmonised at the national level in order to guarantee equal care regardless of the location.

In EDs, triage often takes place on a workstation, although some units still use paper forms. However, sometimes triage must be performed away from the workstation and so quickly that there is no time for paper forms – for example, if the ED has to deal with a large number of patients.

Technology can help in harmonising the guidelines, minimising errors and speeding up the process. Mobile technology can guide the nurse in triage assessment step-by-step, calculate the risk score automatically and give evidence-based instructions to support decision making. This can reduce the triage to intervention time. The digital procedure also improves communication, as the triage assessments and measurements are visible to the entire team almost in real time.

Harmonised recommendations on monitoring vital signs

The NEWS tool was developed for the systematic monitoring of the patient’s condition. Its underlying principle is that the deterioration of a patient’s clinical condition can be detected through changes in physiological measurement results. Originally, the tool was intended for the assessment of inpatients, but studies1 reveal that NEWS is an excellent tool for detecting high-risk patients also in emergency services. This means that the same tool can be used consistently in the patient’s care pathway – from encountering the patient to further care. When the indicators are the same, it is easier to detect changes in the patient’s conditions.

In order to make work easier at the congested emergency departments, it is important to integrate NEWS smoothly into routine tasks – not to increase the workload of the care providers. Traditionally, the NEWS process is performed manually with the help of a pen, paper and a separate NEWS table. However, the process becomes faster by automating the calculation and showing the instructions corresponding to the score immediately to the personnel. Individual measurement results and EWS scores can also be recorded directly to the electronic health record through a smartphone.

Some countries – such as the UK – have already standardised the NEWS nationally. Harmonising the assessment of patients’ condition would improve the equal treatment of patients across care units and enhance the continuity of care.

References:

1. Kivipuro et al. (2018): National early warning score (NEWS) in a Finnish multidisciplinary emergency department and direct vs. late admission to intensive care. Resuscitation.

 


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