Improving recognition of patients at risk in a Portuguese general hospital: results from a preliminary study on the early warning score

Abstract

BackgroundEarly warning score (EWS) is a system that assists in the timely recognition of hospitalized patients outside critical care areas with potential or established critical illness at risk of deteriorating and who may be receiving suboptimal care. No such systems have been implemented in Portuguese National Health Service's wards. We performed a preliminary study to assess the potential outcome of applying the EWS in our hospital setting.MethodsAn observational retrospective study was conducted based on 100 patients assessed by the outreach team due to an acute event. The EWS was calculated a posteriori on three preceding periods from the acute deterioration (−12, −24, and −72 h).ResultsIn 35 patients, there was insufficient recording of vital signs. The final sample of 65 patients includes 62.0% men, and the mean age (±SD) was 67 ± 16 years old. Respiratory problems were the main cause of deterioration (44.6%). The EWS score increased from −72 to −12 h. More than half of cases (63.0%) were admitted into high care units, and their mean (±SD) score was higher in comparison to those remaining in general wards (Intermediate Care Units 3.75 ± 1.9, Intensive Care Units 4.2 ± 1.5, wards 3.5 ± 1.4). Score at −24 and −12 h seemed to predict length of stay (LoS; p < 0.05) and mortality, respectively. The EWS would have incremented early medical attention by 40.0% if a threshold of ≥3 was used.ConclusionsEWS systems are not widely used in Portuguese health service. Our data suggests that the EWS would allow early recognition for a higher number of patients in comparison to current ward care. Clinical worsening, lengths of stay, admission into high care units, and mortality may be predicted by the EWS. Prospective studies with multivariable analysis are needed to clarify the global outcome of the EWS implementation in national wards.

Evaluation of the performance of the modified early warning score in a Brazilian public hospital

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Application of the National Early Warning Score (NEWS) as a stratification tool on admission in an Italian acute medical ward: A perspective study

“…Studies carried out in medical wards with implementation of the MEWS (Modified Early Warning Score), documented its predicting power in identifying subsets of patients at risk of deterioration . Such score differs from the NEWS because it does not consider oxygen saturation and oxygen therapy.…”

“…10 Studies carried out in medical wards with implementation of the MEWS (Modified Early Warning Score), documented its predicting power in identifying subsets of patients at risk of deterioration. 14,20,21 Such score differs from the NEWS because it does not consider oxygen saturation and oxygen therapy. Recently, the ability of the MEWS in predicting serious adverse events in a general hospital population has been examined prospectively.…”

Sistemas De Avaliação Precoce Na Identificação De Morbidades Maternas: Revisão Sistemática

“…Os resultados nos três artigos demonstraram que o instrumento EWS (Early Warning Scores) revelou não ter significância preditiva de morbidades na admissão dos pacientes ou de internação em UTI, apenas uma tendência mais precoce do encaminhamento para essa unidade e uma relação maior entre os pacientes mais velhos pela deterioração aguda dos mesmos CORREIA et al, 2014). Quando aplicado em pacientes obstétricas, não conseguiu categorizar as pacientes de acordo com a gravidade das doenças (CARLE et al, 2013).…”