Continuous Cloud-Based Early Warning Score Surveillance to Improve the Safety of Acutely Ill Hospitalized Patients

Abstract

Introduction: This study sought to evaluate the impact of changes made to the process of continually screening hospitalized patients for decompensation. Methods: Patients admitted to hospital wards were screened using a cloud-based early warning score (modified National Early Warning Score [mNEWS]). Patient with mNEWS ≥7 triggered a structured response. Outcomes of this quality improvement study during the intervention period from February through August 2018 (1741 patients) were compared with a control population (1,610 patients) during the same months of 2017. Results: The intervention group improved the time to the first lactate order within 24 hours of mNEWS ≥7 (p < .001), the primary outcome, compared with the control group. There was no significant improvement in time to intensive care unit (ICU) transfer, ICU length of stay (LOS), or hospital mortality. Among patients with a lactate ordered within 24 hours, there was a 47% reduction of in-hospital mortality (odds ratio 0.53, 95% confidence interval 0.3–0.89, p = .02) and a 4.7 day reduction in hospital LOS (p < .001) for intervention versus control cohorts. Conclusions: Cloud-based electronic surveillance can result in earlier detection of clinical decompensation. This intervention resulted in lower hospital LOS and mortality among patients with early detection of and intervention for clinical decompensation.

Predicting Patient Deterioration: A Review of Tools in the Digital Hospital Setting

“…Several other studies have evaluated screening tools such as the National Early Warning Score, Modified Early Warning Score, Rothman Index, and Sequential Organ Failure Assessment, for the early warning and detection of patient deterioration in hospital settings across different countries [ 26 , 39 , 41 , 50 , 52 , 54 , 57 , 59 , 64 , 65 , 67 ] ( Table 3 ). The evaluation included applying tools retrospectively on historical clinical data to assess the feasibility of future use as well as assessing tools prospectively alongside the standard clinical systems.…”

“…Of the studies detailing the implementation of scoring tools across institutions [ 50 - 52 , 61 , 62 , 64 , 65 ], high-risk patients were appropriately identified as aiding in clinical response ( Table 4 ). However, when comparing intervention and control patient cohorts, differing results were seen with either significant reductions or no impact on the assessed deterioration events.…”

Predicting Patient Deterioration: A Review of Tools in the Digital Hospital Setting (Preprint)

“…Of the studies detailing the implementation of scoring tools across institutions [50][51][52]61,62,64,65], high-risk patients were appropriately identified as aiding in clinical response (Table 4). However, when comparing intervention and control patient cohorts, differing results were seen with either significant reductions or no impact on the assessed deterioration events.…”

“…All patient deterioration prediction tools used vital sign measures, most commonly blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, and a level of consciousness measure (Multimedia Appendix 2, Tables S2 and S3 [ [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][41][42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][63][64][65]67,68]). In addition, most of the models included basic patient demographic data, such as age and gender, as well as administrative measures, such as admission status, time since admission, length of stay, and patient location.…”

Implementation of automated early warning decision support to detect acute decompensation in the emergency department improves hospital mortality

“…We have previously described an improvement in activation of rapid response teams and lactate measurements with ward-based implementation of this cloud-based system. 8 The goal of this investigation was to study the effectiveness of this decision support system to detect and intervene on clinical decompensation in the ED by evaluating reductions in hospital mortality and length of stay (LOS).…”