Introduction of an electronic physiological early warning system: effects on mortality and length of stay

Dawes, Torkil; Cheek, Elizabeth; Bewick, Viv; Dennis, M. J. S.; Duckitt, Roger; Walker, Jeffrey; Forni, Lui G.; Venn, Richard

doi:10.1093/bja/aeu107

Cited by 18 publications

(13 citation statements)

References 13 publications

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“…One Canadian study found that an abbreviated ViEWS gave an AUROC of 0.81 (0.80–0.82) to predict 30-day mortality;14 a US study reported an AUROC of 0.86 (timing of outcome not reported)15 and a Ugandan study reported an AUROC of 0.89 (0.83 to 0.95) to predict mortality within 24 hours of admission 16. Overall mortality was lower than in the original ViEWS derivation study, reflecting a decrease across the NHS for emergency admissions, previously reported 17 18…”

Section: Discussionmentioning

confidence: 81%

A validation of the National Early Warning Score to predict outcome in patients with COPD exacerbation

Hodgson

Dimitrov

Congleton

et al. 2016

Thorax

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This first validation of the NEWS in AECOPD found modest discrimination to predict mortality. Lower specificity of NEWS in patients with AECOPD versus other AMU patients reflects acute and chronic respiratory physiological disturbance (including hypoxia), with resultant low PPV at NEWS=5. CREWS and Salford-NEWS, adjusting for chronic hypoxia, increased the specificity and PPV but there was no gain in discrimination.

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Section: Discussionmentioning

confidence: 81%

A validation of the National Early Warning Score to predict outcome in patients with COPD exacerbation

Hodgson

Dimitrov

Congleton

et al. 2016

Thorax

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“…Vital signs based aggregate early warning score (EWS) systems, which assign weights to each vital sign according to the deviation from assumed normal values, are recommended for routine use in UK hospitals 1,2 . In 2012, the Royal College of Physicians of London (RCPL) published a proposed National EWS (NEWS) 3 , which has now undergone extensive validation [4][5][6] . In NEWS, oxygen saturations (SpO 2 ) receive increasing weights for values of 95% or less, and oxygen therapy receives a flat weight.…”

Section: Introductionmentioning

confidence: 99%

A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

et al. 2019

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Aims: To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes. Methods:We undertook a multi-centre retrospective observational study at five acute hospitals from two UK NHS Trusts. Data were obtained from completed adult admissions who were not fit enough to be discharged alive on the day of admission. Diagnostic coding and oxygen prescriptions were used to identify patients with type II respiratory failure (T2RF). The primary outcome was in-hospital mortality within 24 h of a vital signs observation.Secondary outcomes included unanticipated intensive care unit admission or cardiac arrest within 24 h of a vital signs observation. Discrimination was assessed using the c-statistic.Results: Among 251,266 adult admissions, 48,898 were identified to be at risk of T2RF by diagnostic coding. In this group, NEWS2 showed statistically significant lower discrimination (c-statistic, 95% CI) for identifying in-hospital mortality within 24 h (0.860, 0.857-0.864) than NEWS (0.881, 0.878-0.884). For 1394 admissions with documented T2RF, discrimination was similar for both systems: NEWS2 (0.841, 0.827-0.855), NEWS (0.862, 0.848-0.875). For all secondary endpoints, NEWS2 showed no improvements in discrimination.Conclusions: NEWS2 modifications to NEWS do not improve discrimination of adverse outcomes in patients with documented T2RF and decrease discrimination in patients at risk of T2RF. Further evaluation of the relationship between SpO 2 values, oxygen therapy and risk should be investigated further before wide-scale adoption of NEWS2.

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“…The VitalPac EWS (ViEWS; Prytherch et al 2010) and the derived National Early Warning Score (NEWS; Royal College of Physicians 2012). The implementation and evaluation of EWS systems ranges from paper-based tracking systems (Moon et al 2011) to assisted calculations based on either automatic or manual registrations such as VitalPac, to fully automated systems (Dawes et al 2014;Tarassenko et al 2006). EWS systems are also known as 'track and trigger' (TT) systems, Cogn Tech Work (2015) 17:529-545 531 which describes the necessity of registering patient observations in regular intervals.…”

Section: Related Workmentioning

confidence: 99%

Identifying patients at risk of deterioration in the Joint Emergency Department

Schmidt

Wiil

2015

Cogn Tech Work

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In recent years, Danish hospitals have merged their emergency facilities into Joint Emergency Departments. This poses new collaborative challenges across traditionally separated specialized departments, which now have to collaborate in a shared environment. Despite established protocols and patient monitoring regimes, as many as 31 % of non-critical patients deteriorate with potentially severe consequences. To understand why this may be, we conduct a field study with the aim of investigating what factors external to patients relate to the clinicians' ability to notice adverse events. We look at the case through the lenses of common information spaces. In particular, we apply Bossen's seven-parameter framework to discover new dimensions of how Emergency Departments and individual clinicians identify and respond to unforeseen events, and how they handle the associated cognitive challenges. We complement these findings with a review of a novel taxonomy for patient monitoring. Our contribution is the identification of four improvement areas for patient monitoring platforms in terms of support for the identification of patient deterioration.

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Introduction of an electronic physiological early warning system: effects on mortality and length of stay

Abstract: The introduction of an electronic alerting PSS did not lead to a reduction in mortality when adjusted for severity of illness defined by physiological variables. Predictive performance was not enhanced by the addition of biochemical variables and co-morbidities.

Cited by 18 publications

References 13 publications

A validation of the National Early Warning Score to predict outcome in patients with COPD exacerbation

A validation of the National Early Warning Score to predict outcome in patients with COPD exacerbation

A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

Identifying patients at risk of deterioration in the Joint Emergency Department

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