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Purpose To evaluate the effect of national early warning scoring system (NEWS) implementation in identifying patients at risk of clinical deterioration at an emergency hospital. Background Early warning score has been developed to facilitate early detection of deterioration by categorizing a patients’ severity of illness and prompting nursing staff to request a medical review at specific trigger points. Patients and Methods A prospective, control/intervention groups’, quasi-experimental design was utilized. A sample of 364 adult patients were admitted to the inpatient unit at an emergency hospital for six months. The patients were divided into a study group (174 patients) and a control group (190 patients). All study patients were followed up to either death or hospital discharge before and after implementing a new observation chart. The patients’ outcomes were compared and analyzed between both groups. Results In the intervention period, compared to the control period, a significant reduction was seen in the number of cardiopulmonary arrest (4.7% vs 1.1%, p = 0.046), unplanned ICU admission (5.3% vs 1.7%, p = 0.049), emergency surgery (6.3% vs 0%, p = 0.001), acute kidney injury (6.8% vs 1.1%, p = 0.006). As well, there was a significant increase in the number of patients receiving medical reviews following clinical deterioration in terms of escalation plan (3.2% vs 26.4%, p = <0.001). Conclusion The implementation of NEWS was associated with a significant improvement in patients’ outcomes in hospital wards, increases in the frequency of vital signs measurements, and an increase in the number of medical reviews following clinical instability.

Background: Disturbed sleep is a common complaint in patients with the Chronic Obstructive pulmonary Disease (COPD). Moreover, the factors affecting sleep quality of those patients remain unclear. The aim of this study: was to assess sleep quality among patients with the chronic obstructive pulmonary disease. Material and Methods: A descriptive exploratory design was utilized and conducted at the intermediate respiratory care unit at Mansoura university hospital including a convenient sample of 60 patients of both sexes, able to verbalize their health status and who stayed more than two days at intermediate care unit.Patients' Demographic, Health Relevant Data, Pittsburgh Sleep Quality Index and factors affecting sleep quality instruments were utilized in data collection. Results: Most of the patients were married males, their age ranged between 50 and 69 years with a mean age of 61 and one-third of them were smokers. The majority of patients (80%) had the unsatisfactory level of sleep according to Pittsburgh Sleep Quality Index. The factors altered the patients' sleep included physiological factors such as the production of sputum and chest tightness. The most influential environmental factors included the movement of health care members, performing nursing procedures and administration of nebulizer sessions. The dietary factors included hunger. The influential psychological factors included patients' anxiety and fear of being alone. Finally, daily life habits as daytime naps and smoking. Conclusion and recommendations: It can be concluded that most of the patients had an unsatisfactory level of sleep and need to be improved. As well, further researches are highly recommended on a larger probability sample in different geographical hospitals in Egypt to ensure generalization of findings.

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