In Pirkanmaa, Mobile Early Warning Score Helps Identify Deteriorating Patients On Time
In Pirkanmaa Hospital District (including Tampere University Hospital), the number of mobile Early Warning Score entries has increased by almost 50% compared with last year. This means that an increasing number of patients are risk classified, allowing immediate identification of critically ill patients.
NEWS (National Early Warning Score) is an early warning score system developed in the United Kingdom. The system is based on the principle that deterioration in a patient’s state can be detected by changes in the vital functions (respiratory rate, oxygen saturation, temperature, systolic blood pressure, heart rate and level of consciousness). The criteria guide the carer to increase monitoring of the patient, or if required, to contact the physician on duty and in the event of a significant change also the MET (Medical Emergency Team).
NEWS arrived in Finland on a larger scale in the spring of 2018, when a working group appointed by the Finnish Nurses Association and the Finnish Medical Association drew up a national recommendation for using the score system. Tampere University Hospital was one of the first hospitals to implement the system in 2017. During the same year, they made the risk scoring mobile.
Systematic evaluation of the patient’s state
Doctor Joonas Tirkkonen of the Pirkanmaa Hospital District sees the NEWS criteria as part of modern, comprehensive monitoring of the patient’s state, and Medanet’s mobile app simplifies the implementation of continuous monitoring in the wards.
Nurse Anniina Reinikainen of the Pirkanmaa Hospital District also confirms that entering NEWS points via a mobile device has made the nurses’ work considerably easier:
The mobile solution calculates the points, offers a guideline, and gives instructions for when the next NEWS points should be calculated. The points are entered at the patient’s bedside and the nurse can immediately see the trend of the vital functions, and what the points are made up of. Deviations in the trend helps to predict a deterioration of the patient’s state, and to carry out any necessary measures immediately upon entering the points.
Today, the NEWS warning score system is in use throughout the Pirkanmaa Hospital District, and it is used on mobile in 45 wards. A version tailored to the needs of child patients (Pediatric EWS, or PEWS) was deployed in Tampere’s new children’s hospital in autumn 2019 as part of the hospital’s operational development activities.
Pirkanmaa Hospital District carries out more than 16,000 NEWS risk score evaluations on the Medanets app monthly. This can be benchmarked against the approximately 17,400 patients [1] that are cared for within the hospital district monthly. The guideline is to calculate the NEWS score for a patient a minimum of once per work shift, and even more often for critical patients.
Prevention of adverse events
The majority of adverse events in hospitals may be prevented if the patient’s vital signs are monitored and changes in them are addressed on time [2]. According to research [3], early detection of critical changes in the vital functions can even decrease hospital mortality rates.
Systematic implementation of risk scoring also decreases forced patient transfers to the intensive care unit, when the patient’s deterioration is observed on time. The cost of intensive care is approximately EUR 3,000/day [4], and the most common factor raising medical costs.
References:
[1] Website of Tampere University Hospital. https://www.tays.fi/fi-fi/sairaanhoitopiiri/toiminta_ja_talous/Tilastotietoa
[2] Berlot G, Pangher A, Petrucci L, Bussani R, Lucangelo U. Anticipating events of in-hospital cardiac arrest. Eur J Emerg Med. 2004;11:24–8.
[3] Schmidt PE , Meredith P , Prytherch DR , et al . Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Qual Saf 2015;24:10–20.
[4] Karlsson S, Ala-Kokko T, Pettilä V, Tallgren M ja Valtonen M. 2017. Tehohoito-opas. 5. uudistettu painos, Kustannus Oy Duodecim. Helsinki.
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