An intervention including the national early warning score improves patient monitoring practice and reduces mortality: A cluster randomized controlled trial

Haegdorens, Filip; Monsieurs, Koenraad G.; Meester, Koen De; Bogaert, Peter Van

doi:10.1111/jan.14034

Cited by 25 publications

(29 citation statements)

References 21 publications

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“…In our results, the high-risk cutoff points show that, globally, for the NEWS2 scale, 7 points is where the best joint sensitivity and specificity is obtained-a score that reached 8 points for the SARS-CoV-2 positive population. This fact is in accordance with results from other studies carried out on different populations and health settings [27,45,46].…”

Section: Discussionsupporting

confidence: 93%

Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments

Martin-Rodríguez

Conty

Sanz-García

et al. 2021

JPM

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Early warning scores (EWSs) help prevent and recognize and thereby act as the first signs of clinical and physiological deterioration. The objective of this study is to evaluate different EWSs (National Early Warning Score 2 (NEWS2), quick sequential organ failure assessment score (qSOFA), Modified Rapid Emergency Medicine Score (MREMS) and Rapid Acute Physiology Score (RAPS)) to predict mortality within the first 48 h in patients suspected to have Coronavirus disease 2019 (COVID-19). We conducted a retrospective observational study in patients over 18 years of age who were treated by the advanced life support units and transferred to the emergency departments between March and July of 2020. Each patient was followed for two days registering their final diagnosis and mortality data. A total of 663 patients were included in our study. Early mortality within the first 48 h affected 53 patients (8.3%). The scale with the best capacity to predict early mortality was the National Early Warning Score 2 (NEWS2), with an area under the curve of 0.825 (95% CI: 0.75–0.89). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients presented an area under the curve (AUC) of 0.804 (95% CI: 0.71–0.89), and the negative ones with an AUC of 0.863 (95% CI: 0.76–0.95). Among the EWSs, NEWS2 presented the best predictive power, even when it was separately applied to patients who tested positive and negative for SARS-CoV-2.

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Section: Discussionsupporting

confidence: 93%

Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments

Martin-Rodríguez

Conty

Sanz-García

et al. 2021

JPM

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“…[1][2][3][4][5][6] Underlying causes such as sepsis, acute coronary syndrome and pulmonary embolism may be treated promptly with early detection. [7][8][9][10][11][12] Such delays have been highlighted in the 2018 National Confidential Enquiry into Patient Outcome and Death Common Themes and Recommendations report. 13 In response to the need for early detection, the National Early Warning Score was introduced by the Royal College of Physicians in 2012 with further updates in 2017.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis

et al. 2020

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Objective Delayed response to clinical deterioration as a result of intermittent vital sign monitoring is a cause of preventable morbidity and mortality. This review focuses on the clinical impact of multi-parameter continuous non-invasive monitoring of vital signs (CoNiM) in non-intensive care unit patients. Design Systematic review and meta-analysis of primary studies. Embase, MEDLINE, HMIC, PsycINFO and Cochrane were searched from April 1964 to 18 June 2019 with no language restriction. Setting The search was limited to hospitalised, non-intensive care unit adult patients who had two or more vital signs continuously monitored. Participants All primary studies that evaluated the clinical impact of using multi-parameter CoNiM in adult hospital wards outside of the intensive care unit. Main outcome measures Clinical impact of multi-parameter CoNiM. Results This systematic review identified 14 relevant studies from 3846 search results. Five studies were classified as Group A – associations found between measured vital signs and clinical parameters. Nine studies were classified as Group B – comparison between clinical outcomes of patients with and without multi-parameter CoNiM. Vital signs data from CoNiM were found to associate with type of presenting complaint, level of renal function and incidence of major clinical events. CoNiM also assisted in diagnosis by differentiating between patients with acute heart failure, stroke and sepsis (with sub-clustering of septic patients). In the meta-analysis, patients on multi-parameter CoNiM had a 39% decrease in risk of mortality (risk ratio [RR] 0.61; 95% confidence interval [95% CI] 0.39, 0.95) when compared to patients with regular intermittent monitoring. There was a trend of reduced intensive care unit transfer (RR 0.86; 95% CI 0.67, 1.11) and reduced rapid response team activation (RR 0.61; 95% CI 0.26–1.43). A trend towards reduced hospital length of stay was also found using weighted mean difference (WMD –3.32 days; 95% CI -8.82–2.19 days). Conclusion There is evidence of clinical benefit in implementing CoNiM in non-intensive care unit patients. This review supports the use of multi-parameter CoNiM outside of intensive care unit with further large-scale RCTs required to further affirm clinical impact.

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“…Prior to implementation of a PEW system, there is signi cant variation (25 to 88%) in the frequency of observations 1,2,15 . Two randomised control trials 2,16 and a systematic literature review 17 have shown that following implementation of a PEW system, there is demonstrable improvement in observation performance and patient mortality. It has also been shown that effective identi cation, rather than response team attendance, is associated with these improved outcomes 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Developing and Optimising Observation and Monitoring Guidance for a Paediatric Early Warning System

Duncan¹,

Emms²,

Eyre³

et al. 2020

Preprint

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Background: Hospitalised children experience predictable and potentially preventable life-threatening events in hospital that may be reduced by early warning systems. With the current interest in developing a national PEW system, and in the absence of relevant literature, we present guidance from a mature programme that may be useful to those institutions that are currently planning implementation or modification of an existing system. Objectives: To develop an evidence and expert based observation and monitoring guidance as the standard and recommended practice underpinning a wider Paediatric Early Warning (PEW) system Design: Case study using mixed methods of literature reviews, consultation, focus groups and co-production. Setting: A specialist children’s hospital.Methods: This report outlines the development of the original guidance through consultation and co-production using a literature review and multi-professional focus groups and subsequent iterative changes. Results: The original (2008) and the current (2019) guidance are presented to show the modifications over time including ergonomic chart design, documenting parental concern, continuous monitoring, alarm management, fluid balance and hydration risk assessment, Sepsis 6, conditions to omit and de-escalate observations, and documentation of significant clinical events contemporaneously on the observation chart. Our guidance is compared to the Royal College of Nursing Guidance (2017), which includes good general guidance for performing routine observations correctly, but still limited guidance on the triage/ admission interface, frequency of routine observations, escalation and de-escalation of frequency and type of observations, and specialist observations.Conclusions: We have evolved evidence and expert based observation and monitoring guidance to support the implementation and maintenance of a PEW system over 12 years. The guidance sets standards of care to educate and guide clinicians and provides a template for assessment of that standard of care. TWEETABLE ABSTRACT Evidence and expert based observation and monitoring guidance to support the implementation and maintenance of a Paediatric Early Warning system.

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An intervention including the national early warning score improves patient monitoring practice and reduces mortality: A cluster randomized controlled trial

Cited by 25 publications

References 21 publications

Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments

Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments

Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis

Developing and Optimising Observation and Monitoring Guidance for a Paediatric Early Warning System

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