Showing papers on "Early warning score published in 2012"

A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards.

Abstract: OBJECTIVES: Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes. SETTING: A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia. PATIENTS: Cohort of 18,305 patients. DESIGN: Before-and-after controlled trial. INTERVENTION: We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls; survival to hospital discharge or to 90 days for rapid response team call patients; overall type and number of serious adverse events and length of hospital stay. MEASUREMENTS AND MAIN RESULTS: We studied 9,617 patients before (control) and 8,688 after (intervention) deployment of electronic automated advisory vital signs monitors. Among rapid response team call patients, intervention was associated with an increased proportion of calls secondary to abnormal respiratory vital signs (from 21% to 31%; difference [95% confidence interval] 9.9 [0.1-18.5]; p = .029). Survival immediately after rapid response team treatment and survival to hospital discharge or 90 days increased from 86% to 92% (difference [95% confidence interval] 6.3 [0.0-12.6]; p = .04). Intervention was also associated with a decrease in median length of hospital stay in all patients (unadjusted p < .0001; adjusted p = .09) and more so in U.S. patients (from 3.4 to 3.0 days; unadjusted p < .0001; adjusted ratio [95% confidence interval] 1.03 [1.00-1.06]; p = .026). The time required to complete and record a set of vital signs decreased from 4.1 ± 1.3 mins to 2.5 ± 0.5 mins (difference [95% confidence interval] 1.6 [1.4-1.8]; p < .0001). CONCLUSIONS: Deployment of electronic automated advisory vital signs monitors was associated with an improvement in the proportion of rapid response team-calls triggered by respiratory criteria, increased survival of patients receiving rapid response team calls, and decreased time required for vital signs measurement and recording (NCT01197326).

Early detection of impending physiologic deterioration among patients who are not in intensive care: development of predictive models using data from an automated electronic medical record.

Abstract: BACKGROUND: Ward patients who experience unplanned transfer to intensive care units have excess morbidity and mortality. OBJECTIVE: To develop a predictive model for prediction of unplanned transfer from the medical–surgical ward to intensive care (or death on the ward in a patient who was “full code”) using data from a comprehensive inpatient electronic medical record (EMR). DESIGN: Retrospective case-control study; unit of analysis was a 12-hour patient shift. Shifts where a patient experienced an unplanned transfer were event shifts; shifts without a transfer were comparison shifts. Hospitalization records were transformed into 12-hour shift records, with 10 randomly selected comparison shifts identified for each event shift. Analysis employed logistic regression and split validation. SETTING: Integrated healthcare delivery system in Northern California. PATIENTS: Hospitalized adults at 14 hospitals with comprehensive inpatient EMRs. MEASUREMENTS: Predictors included vital signs, laboratory test results, severity of illness scores, longitudinal chronic illness burden scores, transpired hospital length of stay, and care directives. Patients were also given a retrospective, electronically (not manually assigned) Modified Early Warning Score, or MEWS(re). Outcomes were transfer to the intensive care unit (ICU) from the ward or transitional care unit, or death outside the ICU among patients who were “full code”. RESULTS: We identified 4,036 events and 39,782 comparison shifts from a cohort of 102,422 patients' hospitalizations. The MEWS(re) had a c-statistic of 0.709 in the derivation and 0.698 in the validation dataset; corresponding values for the EMR-based model were 0.845 and 0.775. LIMITATIONS: Using these algorithms requires hospitals with comprehensive inpatient EMRs and longitudinal data. CONCLUSIONS: EMR-based detection of impending deterioration outside the ICU is feasible in integrated healthcare delivery systems. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

Derivation of a cardiac arrest prediction model using ward vital signs

Abstract: Objective:Rapid response team activation criteria were created using expert opinion and have demonstrated variable accuracy in previous studies. We developed a cardiac arrest risk triage score to predict cardiac arrest and compared it to the Modified Early Warning Score, a commonly cited rapid respo

A national early warning score for acutely ill patients

Abstract: A new standard to help identify patients in need of critical care The critical care unit, which clusters patients with life threatening illness in a single geographical area, is now a familiar concept. It offers patients the best chance of survival through optimum technology and the concentration of clinical skills and experience. Critical care medicine is a specialty that depends largely on a resource intensive environment. Until recently, for both economic and practical reasons, critical care could not be provided for every hospital inpatient. As the specialty has developed, it has repeatedly been noted that poor outcomes commonly result from a failure to promptly recognise and treat patients who become acutely ill on a standard hospital ward. As part of a long term strategy to tackle this problem, the Royal College of Physicians has launched a national early warning score.1 This is a welcome development that may be good news for patients. However, it is worth highlighting some potential pitfalls. Patients die not from their disease but from the disordered physiology caused by the disease. The early warning score is an established tool that uses this concept …

Prediction of cardiac arrest in critically ill patients presenting to the emergency department using a machine learning score incorporating heart rate variability compared with the modified early warning score

Abstract: A key aim of triage is to identify those with high risk of cardiac arrest, as they require intensive monitoring, resuscitation facilities, and early intervention. We aim to validate a novel machine learning (ML) score incorporating heart rate variability (HRV) for triage of critically ill patients presenting to the emergency department by comparing the area under the curve, sensitivity and specificity with the modified early warning score (MEWS). We conducted a prospective observational study of critically ill patients (Patient Acuity Category Scale 1 and 2) in an emergency department of a tertiary hospital. At presentation, HRV parameters generated from a 5-minute electrocardiogram recording are incorporated with age and vital signs to generate the ML score for each patient. The patients are then followed up for outcomes of cardiac arrest or death. From June 2006 to June 2008 we enrolled 925 patients. The area under the receiver operating characteristic curve (AUROC) for ML scores in predicting cardiac arrest within 72 hours is 0.781, compared with 0.680 for MEWS (difference in AUROC: 0.101, 95% confidence interval: 0.006 to 0.197). As for in-hospital death, the area under the curve for ML score is 0.741, compared with 0.693 for MEWS (difference in AUROC: 0.048, 95% confidence interval: -0.023 to 0.119). A cutoff ML score ≥ 60 predicted cardiac arrest with a sensitivity of 84.1%, specificity of 72.3% and negative predictive value of 98.8%. A cutoff MEWS ≥ 3 predicted cardiac arrest with a sensitivity of 74.4%, specificity of 54.2% and negative predictive value of 97.8%. We found ML scores to be more accurate than the MEWS in predicting cardiac arrest within 72 hours. There is potential to develop bedside devices for risk stratification based on cardiac arrest prediction.

NEWSDIG: The National Early Warning Score Development and Implementation Group

Abstract: The National Early Warning Score Development and Implementation Group (NEWSDIG) was a group convened by the Royal College of Physicians to develop a new early warning score (EWS) system that would be validated, easily learnt and used, and widely implemented. The Acute Medicine Task Force[1][1] that

The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational study.

Abstract: ContextThe Modified Early Warning Score is a validated assessment tool for detecting risk of deterioration in patients at risk on medical and surgical wards.ObjectiveTo assess the prognostic ability of the Modified Early Warning Score in predicting outcome after critical care.DesignA prospective obs

Effectiveness of Modified Early Warning Score in predicting outcomes in oncology patients

Abstract: Background: Patients at risk of rapid deterioration and critical illness often have preceding changes in physiological parameters. Track and trigger systems, such as the Modified Early Warning Score (MEWS) used in the UK, have been demonstrated to have some utility in identifying these patients particularly among general medical and surgical patients. Aim: Assess the effectiveness of MEWS and the proposed (NHS Early Warning Score) in oncology patients. Identify the key physiological parameters that predict outcome in this cohort. Design: We performed a retrospective analysis at a specialist oncology hospital in the North West of England. Method: The data for 840 patients reviewed by the Outreach Team between April 2009 and January 2011 was analysed. The effectiveness of the MEWS in predicting Critical Care admission and 30 day mortality was assessed. Statistical analysis to identify the key physiological parameters in predicting these two outcomes was also performed. Results: The MEWS score was statistically significant in predicting both outcome measures (CCU admission P = 0.037 and 30 day mortality P = 0.004). Respiratory rate ( P = 0.0003/ P = 0.0001) and temperature ( P = 0.033/ P ≤ 0.0001) were the key physiological variables in predicting clinical deterioration. Blood pressure ( P = 0.999/ P = 0.619) and pulse rate ( P = 0.446/ P = 0.051) did not have statistical significance in predicting either outcome. However, analysis of receiver operator curves showed that MEWS had poor value in predicting both outcomes (0.55 and 0.6, respectively). Conclusions: The currently used track and trigger systems have poor discriminatory value in identifying Oncological patients at risk of deterioration. An adapted score more focused upon the key predictive physiological parameters in this population needs to be developed to produce a more effective tool.

Gaussian process regression in vital-sign early warning systems

Abstract: The current standard of clinical practice for patient monitoring in most developed nations is connection of patients to vital-sign monitors, combined with frequent manual observation. In some nations, such as the UK, manual early warning score (EWS) systems have been mandated for use, in which scores are assigned to the manual observations, and care escalated if the scores exceed some pre-defined threshold. We argue that this manual system is far from ideal, and can be improved using machine learning techniques. We propose a system based on Gaussian process regression for improving the efficacy of existing EWS systems, and then demonstrate the method using manual observation of vital signs from a large-scale clinical study.

Accuracy of an expanded early warning score for patients in general and trauma surgery wards.

Abstract: Background: Early warning scores (EWS) may aid the prediction of major adverse events in hospitalized patients. Recently, an expanded EWS was introduced in the Netherlands. The aim of this study was to assess the relationship between this EWS and the occurrence of major adverse clinical events during hospitalization of patients admitted to a general and trauma surgery ward. Methods: This was a prospective cohort study of consecutive patients admitted to the general and trauma surgery ward of a university medical centre (March–September 2009). Follow-up was limited to the time the patient was hospitalized. Logistic regression analysis was used to assess the relationship between the EWS and the occurrence of the composite endpoint consisting of death, reanimation, unexpected intensive care unit admission, emergency surgery and severe complications. Performance of the EWS was analysed using sensitivity, specificity, predictive values and receiver operating characteristic (ROC) curves. Results: A total of 572 patients were included. During a median follow-up of 4 days, 46 patients (8.0 per cent) reached the composite endpoint (two deaths, two reanimations, 17 intensive care unit admissions, 44 severe complications, one emergency operation). An EWS of at least 3, adjusted for baseline American Society of Anesthesiology classification, was associated with a significantly higher risk of reaching the composite endpoint (odds ratio 11·3, 95 per cent confidence interval (c.i.) 5·5 to 22·9). The area under the ROC curve was 0·87 (95 per cent c.i. 0·81 to 0·93). When considering an EWS of at least 3 to be a positive test result, sensitivity was 74 per cent and specificity was 82 per cent. Conclusion: An EWS of 3 or more is an independent predictor of major adverse events in patients admitted to a general and trauma surgery ward. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

The use of a modified pediatric early warning score to assess stability of pediatric patients during transport.

Abstract: Objective: Pediatric early warning scores (PEWSs) have been used effectively in limited patient care areas. Children's Transport, at Children's Healthcare of Atlanta, transports approximately 5000 children annually. In an effort to consistently assess patient acuity and the impact of our team's interventions, we instituted a modified "transport PEWS" (TPEWS). Methods: The existing PEWS was modified to reflect the transport environment. A retrospective chart review was conducted of 100 consecutive children transported by Children's Transport in March 2009. Transport PEWS given during triage by the dispatch center (TPEWS tri ), TPEWS calculated at referring facility by the team (TPEWS ref ), and final TPEWS at the accepting institution (TPEWS acc ) were compared. Results: Eighty-six patients were transported by ground. The median age was 50.4 months. Sixty patients (60%) received some intervention from the transport team. Median TPEWS ref was 3 (0-9) upon initial assessment, and TPEWS acc was 2 (0-9) on arrival at the accepting facility (P = 0.0001). Seventy-three percent (73/100) of patients were transported to the emergency room; 15 (15%) of 100 to the general inpatient area, and 12 (12%) of 100 to the intensive care unit. In addition, a triage TPEWS (TPEWS tri ) was calculated from information given from the referring facility in 59 of the 100 patients. A significant difference in TPEWS tri and TPEWS ref was noted (P = 0.0001). Conclusions: In this cohort of pediatric transport patients, TPEWS appears to be a helpful additional assessment tool. Transport PEWS may function as a tool for assessing severity of illness, hence optimizing transport dispatch and patient disposition.

The use of Modified Early Warning Score may help anesthesists in postoperative level of care selection in emergency abdominal surgery.

Abstract: Background The Modified Early Warning Score (MEWS) was proposed for early identification of patients deterioration. The purpose of this study was to determine if MEWS calculation can help the anaesthesist select the correct level of care to avoid inappropriate admission to the ICU and to enhance the use of the High Dependency Unit (HDU) after emergency surgical procedures. Methods Emergency surgical patients admitted before MEWS application (Jan 2008-Mar 2009) were included in the control group, whereas emergency surgical patients after MEWS introduction constituted the intervention group (Apr 2009-Jan 2010). Admission diagnosis was included into three groups for data analysis: acute abdomen (intestinal occlusion, bowel perforation, intestinal ischemia), non-complicated surgery (hernia recurrence, cholecystitis, appendicitis), and blunt abdominal trauma. In intervention group, MEWS was calculated by the anaesthesists on duty before and after surgical procedure. Patients with a MEWS of 3 or 4 were transferred to the HDU, whereas a MEWS score of 5 or more was considered criteria for ICU admission. Results A total of 1082 patients were enrolled in this study. The control group was made up of 604 patients, whereas the MEWS group included 478 patients. Baseline and clinical status were comparable between groups. After MEWS introduction, HDU admissions significantly increased from 14% to 21% (P=0.0008), with a significant decrease of ICU admissions (from 11% to 5%; P=0.0010). Mortality rate analysis did not differ between groups. Conclusion This study suggests that the use of a simple and reproducible score system may help in reducing ICU admissions after emergency surgery.

Optimising fast track care for proximal femoral fracture patients using modified early warning score.

Abstract: INTRODUCTIONThe care for patients with a proximal femoral fracture has been dramatically overhauled with the introduction of ‘fast track’ protocols and the British Orthopaedic Association guidance in 2007. Fast track pathways focus on streamlining patient flow through the emergency department where the guidance addresses standards of care. We prospectively examined the impact these protocols have on patient care and propose an alternative ‘streamed care’ pathway to provide improved medical care within existing resource constraints. METHODSData surrounding the treatment of 156 consecutive patients managed at 4 centres were collated prospectively. Management of patients with a traditional fast track protocol allowed 17% of patients to leave the emergency department with undiagnosed serious medical pathology and 32% with suboptimal fluid resuscitation. A streamed care pathway based on the modified early warning score was developed and employed for 48 further patients as an alternative to the traditional fast...

National Early Warning Score

Abstract: Disclaimer The National Governance/National Clinical Guideline Development Group's expectation is that healthcare professionals will use clinical judgement, medical and nursing knowledge in applying the general principles and recommendations contained in this document. Recommendations may not be appropriate in all circumstances and decisions to adopt specific recommendations should be made by the practitioner taking into account the circumstances presented by individual patients and available resources. The National Clinical Effectiveness Committee (NCEC) was established as part of the Patient Safety First Initiative in September 2010. The NCECs mission is to provide a framework for national endorsement of clinical guidelines and audit to optimise patient and service user care. The NCEC has a remit to establish and implement processes for the prioritisation and quality assurance of clinical guidelines and clinical audit so as to recommend them to the Minister for Health to become part of a suite of National Clinical Guidelines and National Clinical Audit. National Clinical Guidelines are \" systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users' decisions about appropriate healthcare for specific clinical circumstances across the entire clinical system \". The implementation of clinical guidelines can improve health outcomes, reduce variation in practice and improve the quality of clinical decisions. The aim of National Clinical Guidelines is to provide guidance and standards for improving the quality, safety and cost effectiveness of healthcare in Ireland. The implementation of these National Clinical Guidelines will support the provision of evidence based and consistent care across Irish healthcare services. The oversight of the National Framework for Clinical Effectiveness is provided by the National Clinical Effectiveness Committee (NCEC). The NCEC is a partnership between key stakeholders in patient safety and its Terms of Reference are to:-Apply criteria for the prioritisation of clinical guidelines and audit for the Irish health system-Apply criteria for quality assurance of clinical guidelines and audit for the Irish health system-Disseminate a template on how a clinical guideline and audit should be structured, how audit will be linked to the clinical guideline and how and with what methodology it should be pursued-Recommend clinical guidelines and national audit, which have been quality assured against these criteria, for Ministerial endorsement within the Irish health system-Facilitate with other agencies the dissemination of endorsed clinical guidelines and audit outcomes to front-line staff and to the public in an appropriate format-Report periodically on the implementation of endorsed clinical guidelines. …

Using a local early warning scoring system as a model for the introduction of a national system.

Abstract: Background Chelsea and Westminster Hospital introduced the Chelsea Early Warning Score (CEWS) in 2007 to aid the recognition of acutely unwell patients. The Royal College of Physicians subsequently recommended a National Early Warning Score (NEWS) for implementation across the NHS. The aim of this study was to evaluate local adherence to CEWS to identify potential obstacles to the consistent implementation of NEWS. Method Emergency Department (ED) and Acute Assessment Unit (AAU) notes were retrospectively reviewed for a convenience sample of 102 patients admitted to the AAU. Outcome measures were completeness of documentation of CEWS parameters, documentation and accuracy of aggregate CEWS scores. Aggregate NEWS scores were calculated from the documented observations and the calculated CEWS and NEWS scores were compared. Results Physiological observations were documented for all patients attending the ED and AAU. Heart rate, blood pressure, respiratory rate, oxygen saturation and conscious level were documented in over 95% of ED and AAU patients. Urine output was recorded for only 48% of ED and 69% of AAU patients. Aggregate CEWS scores were documented for 66% of ED and 84% of AAU patients. These were calculated accurately in 73% of ED and 79% of AAU patients. Calculation errors were eleven times more likely to result in under-scoring than over-scoring. NEWS scores were significantly higher than CEWS for the same observations and would have resulted in a 71% increase in patients requiring escalation of care in the ED and a 116% increase in AAU. Conclusion Concerns highlighted with CEWS were the incomplete and inaccurate recording of aggregate scores, with underscoring resulting in the potential failure to recognise deteriorating patients. It is anticipated that NEWS will be accompanied by standardised documentation and training across the NHS which will support more complete and accurate recording of physiological data. Furthermore, NEWS appears from this study to be more sensitive than CEWS, thereby minimising the chance of missed deterioration.

National early warning score (NEWS) is not suitable for all patients.

Abstract: McGinlay and Pearse worry about the use of the national early warning score (NEWS) in people recovering from brain injury,1 2 but its insensitivity in people developing acute brain insults is also worrying. In the assessment of brain dysfunction, NEWS depends solely on the “alert, verbal, pain, unresponsive (AVPU)” system. Although useful in initial triage, such simplicity is inadequate in monitoring hospital patients at risk of neurological deterioration. Crucially, AVPU findings are compressed to only …

S29 The Proposed National Early Warning System (NEWS) Could Be Hazardous For Patients Who Are at Risk of Hypercapnic Respiratory Failure

Abstract: Introduction Early Warning Scoring systems (EWS) identify critical illness at an early stage. The Royal College of Physicians has proposed use of a ‘National Early Warning Score’ (NEWS) across UK hospitals. The NEWS allocates EWS points for oxygen saturation Methods We calculated EWS scores using the NEWS and AltNEWS for 108 unselected acute medical patients at a single time point. Results 34/108 general medical patients (31%) had risk factors for T2RF (30 COPD, 4 obstructive sleep apnoea). Nineteen of these 34 patients had saturations within their target range of 88–92% either on air or oxygen. The NEWS system allocated these patients 2 or 3 EWS points for “low” oxygen levels which could prompt nursing staff to increase supplemental oxygen, potentially precipitating dangerous hypercapnia. Three of these 34 patients had saturations >92% on oxygen. The NEWS did not alert nursing staff that supplemental oxygen should be reduced for these patients; saturations of 93–94% were actually scored as “too low”. This could prompt nursing staff to further increase supplemental oxygen which could harm these patients. The AltNEWS allocated EWS points according to whether patients were in or out of range and no patients were placed at risk of T2RF. Conclusion The NEWS system makes no allowance for patients at risk of T2RF. This may lead to potentially dangerous use of oxygen in this substantial group of patients. We recommend that a target oxygen saturation range should be set for all hospital patients on admission and oxygen scores within EWS systems should be adjusted to alert clinicians to scores above and below the target range.

Warning scores in triage - Is there any point? Les scores d'alerte dans le triage: Est-ce vraiment utile?

Abstract: Introduction: The South African Triage Scale (SATS), a novel triage system for Emer- gency Centres, was initially proposed in 2006. The system incorporates an adapted version of the Modified Early Warning Score (MEWS). Methods: A prospective study was conducted to evaluate the use of the MEWS as a triage tool in EC settings in the Western Cape, South Africa. A total of 1867 cases were prospectively assessed. The MEWS was correlated with Emergency Centre outcome Results: The data show clear potential for use of the MEWS as a triage instrument for medical patients. Its use for trauma cases is more limited. Conclusion: The MEWS in its un-adapted form is unsuitable as a unified triage scoring system for both medical and trauma cases in Emergency Centres.

Comparison of CATs, CURB-65 and PMEWS as triage tools in pandemic influenza admissions to UK hospitals: case control analysis using retrospective data.

Abstract: Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs), the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS); to predict higher levels of care (high dependency - Level 2 or intensive care - Level 3) and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children) with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC), sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI): CATs 0.77 (0.73, 0.80); CURB-65 0.68 (0.64, 0.72); PMEWS 0.68 (0.64, 0.73), p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80); CURB-65 0.52 (0.46, 0.59); PMEWS 0.69 (0.62, 0.75), p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages.

Royal college recommends national system to recognise deteriorating patients

Abstract: All acutely ill adult patients in NHS hospitals should be assessed by the same standardised clinical dataset to help detect those who are deteriorating rapidly and who need more intensive support, a working party from the Royal College of Physicians of London has recommended. The national early warning score (NEWS) would be used to assess acute illness, detect deterioration in a patient’s condition, and prompt a timely and competent clinical response. Such a “track and trigger” system, implemented to a common pattern nationally, would make for a step change in the care of acute illness, said Richard Thompson, the college’s president. Many hospitals already have such systems in place, admitted Bryan Williams, professor of medicine at University College London, who chaired the group responsible for the recommendation. These systems represent a lot of work, and their originators are firmly wedded to them, …

Adoption of an electronic observation chart with an integrated early warning scoring system on pilot wards: a descriptive report.

Abstract: The charting of physiological variables in hospital inpatients allows for recognition and treatment of deteriorating patients. The use of electronic records to capture patients' vital signs is still in its infancy in the United Kingdom. The main objective of this article was to describe the adoption of an electronic observation charting function integrated into an established bedside e-prescribing record system on acute wards in a large English university hospital. This new function also has the capability of contacting Critical Care Outreach and clinical staff when patients deteriorate. Data captured over a 4-month period from the pilot wards showed that 80% of observation sets were completed sufficiently to produce early warning scores over the time period. A daily average of 419 Standardized Early Warning Score produced 74 alerts to clinical staff, and two critical alarms per day were e-mailed to the Outreach team. The wards showed different levels of completeness of observations (from 69% to 92%). Although a good overall rate of completeness of physiological data was found, traditional gaps in observation recording documented in the literature (eg, recording of respiratory rate) were still apparent. This system can be used for audit for targeted staff education and to evaluate the Critical Care Outreach service.

Does the use of a track and trigger warning system reduce mortality in trauma patients

Abstract: Introduction Despite the lack of robust evidence, numerous different track and trigger warning systems have been implemented. The MEWS (Modified Early Warning Score system) is one such example, and has not been validated in an emergency trauma setting. A considerable proportion of trauma admissions are elderly patients with co-morbidities. Early recognition of physiological deterioration and prompt action could therefore be lifesaving. Aim Identify whether the implementation of a MEWS system coupled with an outreach service had resulted in a reduction in the mortality within our unit. Method Retrospective study. The MEWS was implemented in 3 Trauma and Orthopaedic wards at the Leicester Royal Infirmary in the summer of 2005. The number of emergency trauma inpatient admissions and deaths from January 2002 to December 2009 were obtained. The diagnosis, primary procedures and cause of death, if known, were noted. Comparisons between pre and post MEWS implementation made. Results 32,149 admissions (55% male; 45% female) with 889 deaths (67% female; 33% male, P Conclusion Mortality has not reduced since the introduction of MEWS to our trauma unit. In view of the apparent lack of clinical effectiveness of the MEWS/outreach partnership, we question the cost effectiveness of this initiative. Possible reasons may include: failure of the MEWS to be correctly applied; inadequate action once the threshold is triggered; or unsuitability of this tool for this patient population. A better system for identifying and treating trauma patients needs to be developed, which is suited to elderly patients with co-morbidities.

Accuracy of an expanded early warning score for patients in general and trauma surgery wards (Br J Surg 2012; 99: 192-197).

Abstract: Background: Early warning scores (EWS) may aid the prediction of major adverse events in hospitalized patients. Recently, an expanded EWS was introduced in the Netherlands. The aim of this study was to assess the relationship between this EWS and the occurrence of major adverse clinical events during hospitalization of patients admitted to a general and trauma surgery ward. Methods: This was a prospective cohort study of consecutive patients admitted to the general and trauma surgery ward of a university medical centre (March–September 2009). Follow-up was limited to the time the patient was hospitalized. Logistic regression analysis was used to assess the relationship between the EWS and the occurrence of the composite endpoint consisting of death, reanimation, unexpected intensive care unit admission, emergency surgery and severe complications. Performance of the EWS was analysed using sensitivity, specificity, predictive values and receiver operating characteristic (ROC) curves. Results: A total of 572 patients were included. During a median follow-up of 4 days, 46 patients (8.0 per cent) reached the composite endpoint (two deaths, two reanimations, 17 intensive care unit admissions, 44 severe complications, one emergency operation). An EWS of at least 3, adjusted for baseline American Society of Anesthesiology classification, was associated with a significantly higher risk of reaching the composite endpoint (odds ratio 11·3, 95 per cent confidence interval (c.i.) 5·5 to 22·9). The area under the ROC curve was 0·87 (95 per cent c.i. 0·81 to 0·93). When considering an EWS of at least 3 to be a positive test result, sensitivity was 74 per cent and specificity was 82 per cent. Conclusion: An EWS of 3 or more is an independent predictor of major adverse events in patients admitted to a general and trauma surgery ward.

Doctors urge hospitals to adopt national system for scoring acutely ill patients

Abstract: The launch of the national early warning score (NEWS) for adults this week by the Royal College of Physicians has been welcomed by doctors in acute medicine who are urging hospitals to embrace the system.1 2 The NEWS is the first national system for scoring acutely ill patients in the world. It has been developed by the Royal College of Physicians after detailed analysis of many of the hundreds of early warning scoring scores currently used in the NHS, including a systematic review3 and consultation with clinicians and nurses. It has the potential to dramatically improve clinical outcomes by recognising rapidly deteriorating patients and triggering an appropriate response, says the college. Speaking at the launch of NEWS at a press conference in London Bryan Williams, chair of the working party behind the system and professor of medicine at University …

Early warning scores and chronic respiratory disease

Abstract: Editor – The article by O'Driscoll et al ( Clin Med February 2012 pp79–81)[1][1] describes some of the challenges of providing an early warning score (EWS) based on vital signs observation for use in all adult patients in acute hospital settings, given the specific physiology of patients with