EWS improves patient’s prognosis
This blog article was published 31.10.2017 and thoroughly updated 30.8.2022.
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. Up to 80% of in-hospital adverse events are preceded by hours of critical disorders of the basic vital functions.1 According to recent a study, the Early Warning Score discriminates patients at risk for acute death within the first two hospital days with excellent statistical accuracy2.
As disorders of vital functions are revealed by changes in physiological observation values, such as heart rate, systolic blood pressure, oxygen saturation and respiratory rate, most adverse events could be prevented or mitigated if the patients’ vital signs were monitored, and any changes met with a timely response. Of the individual parameters, respiratory rate seems to be the best predictor of acute risk of death2.
Early Warning Score (EWS) is a tool developed for the systematic assessment of vital signs. National Early Warning Score, NEWS, is one of its validated versions. The measured values are scored on a scale of 0-3 according to how much they deviate from the normal range. The total score indicates the patient’s risk category (low, medium or high), for which the hospital determines corresponding clinical measures.
Technology enhances the EWS process
The EWS is a simple tool that helps healthcare professionals identify deteriorating patients in a timely manner. Initially, the process has been paper-based. However, many hospitals have adopted electronic and mobile tools for EWS processes, due to their much better usability. Studies have shown that the electronically collected and calculated EWS is more reliable and accurate than the paper-based method3.
With the mobile solution, the patient’s vital signs can be documented right at the point of care. The mobile solution calculates the score automatically and shows the corresponding clinical guideline, together with a trend view of previously calculated scores, to the healthcare professional.
The main advantage of the electronic NEWS is that it doesn’t cause any additional burden to healthcare professionals – neither during collection nor calculation. The patient data needed for the calculation is collected as part of the routine care process, and when documented at the point of care, it is accessible even in real time. What is more, the score calculation is automated, which reduces errors easily made in the paper-based process.
Reduced triage-to-intervention time
According to a study4 published in 2018, and a few others supporting the results, the median triage-to-intervention time was reduced from 12 hours and 24 minutes to 27 minutes after the adoption of electronic warning system for clinical signs of infection, compared to manual surveillance. All in all, this can significantly improve the patient’s prognosis and even reduce in-hospital mortality.
The use of EWS in nursing also reduces costs. At best, early detection of deterioration helps avoid expensive stays in intensive care units. As the patients get the needed treatment sooner, the overall length of hospital stays can be shortened.
Sources:
1. Tirkkonen (2015): Detecting and Reacting to In-hospital Patient Deterioration Studies on the afferent and efferent limbs of the Rapid Response System.
2. Loisa et al. (2022): Ability of the National Early Warning Score and its respiratory and haemodynamic subcomponents to predict short-term mortality on general wards: a prospective three-centre observational study in Finland. BMJ Open.
3. Mohammed et al. (2009): Improving accuracy and efficiency of early warning scores in acute care. Br J Nurs.
4. Westphal et al. (2018): An electronic warning system helps reduce the time to diagnosis of sepsis. Revista Brasileira de terapia intensiva.
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