scholarly journals A proposed Primary Health Early Warning Score (PHEWS) with emphasis on early detection of sepsis in the elderly

2016 ◽  
Vol 8 (1) ◽  
pp. 5 ◽  
Author(s):  
Ian Anderson
Keyword(s):  
Primary Care ◽  
Early Detection ◽  
Acute Care ◽  
Early Warning ◽  
Secondary Care ◽  
The Elderly ◽  
Early Warning Score ◽  
Severe Illness ◽  
Primary Health ◽  
Early Warning Scores

ABSTRACT There are several secondary care early warning scores which alert for severe illness including sepsis. None are specifically adjusted for primary care. A Primary Health Early Warning Score (PHEWS) is proposed which incorporates practical parameters from both secondary and primary care. KEYWORDS: Emergency medical services; acute care; sepsis; early intervention

scholarly journals Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care

2020 ◽  
Vol 70 (695) ◽  
pp. e374-e380 ◽  
Author(s):  
Lauren J Scott ◽  
Niamh M Redmond ◽  
Alison Tavaré ◽  
Hannah Little ◽  
Seema Srivastava ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Clinical Outcomes ◽  
Early Warning ◽  
Secondary Care ◽  
Early Warning Score ◽  
Medical Review ◽  
News Values ◽  
Process Measures ◽  
Sepsis Diagnosis

BackgroundNHS England has mandated use of the National Early Warning Score (NEWS), more recently NEWS2, in acute settings, and suggested its use in primary care. However, there is reluctance from GPs to adopt NEWS/NEWS2.AimTo assess whether NEWS calculated at the point of GP referral into hospital is associated with outcomes in secondary care.Design and settingAn observational study using routinely collected data from primary and secondary care.MethodNEWS values were prospectively collected for 13 047 GP referrals into acute care between July 2017 and December 2018. NEWS values were examined and multivariate linear and logistic regression used to assess associations with process measures and clinical outcomes.ResultsHigher NEWS values were associated with faster conveyance for patients travelling by ambulance, for example, median 94 minutes (interquartile range [IQR] 69–139) for NEWS ≥7; median 132 minutes, (IQR 84–236) for NEWS = 0 to 2); faster time from hospital arrival to medical review (54 minutes [IQR 25–114] for NEWS ≥7; 78 minutes [IQR 34–158] for NEWS = 0 to 2); as well as increased length of stay (5 days [IQR 2–11] versus 1 day [IQR 0–5]); intensive care unit admissions (2.0% versus 0.5%); sepsis diagnosis (11.7% versus 2.5%); and mortality, for example, 30-day mortality 12.0% versus 4.1% for NEWS ≥7 versus NEWS = 0 to 2, respectively. On average, for patients referred without a NEWS value (NEWS = NR), most clinical outcomes were comparable with patients with NEWS = 3 to 4, but ambulance conveyance time and time to medical review were comparable with patients with NEWS = 0 to 2.ConclusionThis study has demonstrated that higher NEWS values calculated at GP referral into hospital are associated with a faster medical review and poorer clinical outcomes.

scholarly journals Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis

JAMIA Open ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. 261-268
Author(s):  
Devin J Horton ◽  
Kencee K Graves ◽  
Polina V Kukhareva ◽  
Stacy A Johnson ◽  
Maribel Cedillo ◽  
...  
Keyword(s):  
Decision Support ◽  
Acute Care ◽  
Direct Cost ◽  
Clinical Decision Support ◽  
Early Warning ◽  
Clinical Decision ◽  
Early Warning Score ◽  
Total Direct Cost ◽  
Intervention Period ◽  
Support Cost

Abstract Objective The objective of this study was to assess the clinical and financial impact of a quality improvement project that utilized a modified Early Warning Score (mEWS)-based clinical decision support intervention targeting early recognition of sepsis decompensation. Materials and Methods We conducted a retrospective, interrupted time series study on all adult patients who received a diagnosis of sepsis and were exposed to an acute care floor with the intervention. Primary outcomes (total direct cost, length of stay [LOS], and mortality) were aggregated for each study month for the post-intervention period (March 1, 2016–February 28, 2017, n = 2118 visits) and compared to the pre-intervention period (November 1, 2014–October 31, 2015, n = 1546 visits). Results The intervention was associated with a decrease in median total direct cost and hospital LOS by 23% (P = .047) and .63 days (P = .059), respectively. There was no significant change in mortality. Discussion The implementation of an mEWS-based clinical decision support system in eight acute care floors at an academic medical center was associated with reduced total direct cost and LOS for patients hospitalized with sepsis. This was seen without an associated increase in intensive care unit utilization or broad-spectrum antibiotic use. Conclusion An automated sepsis decompensation detection system has the potential to improve clinical and financial outcomes such as LOS and total direct cost. Further evaluation is needed to validate generalizability and to understand the relative importance of individual elements of the intervention.

scholarly journals COMBINING VARIOUS FORMS OF TREATMENT TO HEALTH: A STUDY OF ELDERLY IN PRIMARY CARE

2016 ◽  
Vol 25 (3) ◽  
Author(s):  
Luciane Paula Batista Araújo de Oliveira ◽  
Sílvia Maria Azevedo dos Santos
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Daily Life ◽  
Rio Grande ◽  
The Elderly ◽  
Support Network ◽  
Santa Cruz ◽  
Primary Health ◽  
Concurrent Use ◽  
The Subject

ABSTRACT The study aimed to analyze the contextual conditions that influence the use of medications in elderly assisted in primary health care. Qualitative study with contribution of Grounded Theory, held in Santa Cruz, Rio Grande do Norte, Brazil, where 30 elderly patients on medications were interviewed . Data were coded and a model consisting of nine categories was generated. The two categories that explain the contextual conditions of the phenomenon are, Interacting with the support network and The concurrent use of medicines, teas, home remedies and faith, but only the latter is the subject of discussion in this article. To accommodate various treatments, the elderly tried to understand and compare their functions and exercise the faith in God. The act of reconciling different treatments is part of contextual conditions that influence the phenomenon studied, creating a set of circumstances to which these seniors accounted seeking strategies to deal with drug use in daily life.

scholarly journals IMPLEMENTATION OF EARLY WARNING SYSTEM IN NURSING WARD: A LITERATURE REVIEW

2021 ◽  
Vol 10 (1) ◽  
pp. 126-134
Author(s):  
Meli Diana ◽  
Dimas Hadi Prayoga ◽  
Dini Prastyo Wijayanti
Keyword(s):  
Early Detection ◽  
Early Warning ◽  
Scoring System ◽  
Early Warning System ◽  
Sudden Cardiac Arrest ◽  
Warning System ◽  
High Rate ◽  
Early Warning Score ◽  
Score System ◽  
Emergency Detection

Background: Hospital service is a process that involves all elements in the hospital including nurses and inpatient rooms or nursing wards. Different inpatient conditions will be treated in separated wards, by the same token patients with unstable conditions are admitted in intensive care units, this procedure aims to reduce the mortality incidence due to sudden cardiac arrest, therefore early detection of patients’ clinical deterioration using the early warning score system performed by the nurse in the nursing wards is required. Objective: This review study is a summary of the early warning system implementation in the nursing wards. Design: The data was obtained from international journal providers Proquest and Ebsco databases. The author accessed unair.remotexs.co website. Review Methods: Narative Review. Results: Early warning score is an effective intervention for emergency detection in patients. Conclusion: Early detection clinical emergency or known as the Early Warning Score System (EWSS) is the application of a scoring system for early detection of patient's condition before a worsening situation occurs. The implementation of this scoring system is necessary due to the high rate of deterioration of patient conditions that requiring immediate management to prevent profound deterioration and its subsequent adverse effect Keywords : Early warning system;nurse care;literatur;review

scholarly journals Analysis of Implementation of EWSS (Early Warning Score Systems) Against AvLos (Average Length of Stay) and the Trust of Patients in Inpatient Installation at Jombang General Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 348-356
Author(s):  
Sutikno Sutikno ◽  
Sandu Siyoto ◽  
Byba Melda Suhita
Keyword(s):  
Quality Of Service ◽  
Early Detection ◽  
Early Warning ◽  
Health Care Quality ◽  
Early Warning Systems ◽  
Care Quality ◽  
Early Warning Score ◽  
Warning Systems ◽  
General Hospitals

Hospitals are required to always improve the quality of service provided to patients. These challenges have forced the hospital to develop its ability to manifest in various aspects of health care quality responsible. One of them by applying the assessment and early detection in patients kegawatan as well as the critical state of activation becomes very important. Quick and proper response to a nurse against the worsening conditions of patients giving a great impact to the quality of the quality of service provided. The purpose of this research is to analyze the implementation of Early Warning systems (EWSS) Score against AvLOS and trust patients in Inpatient installation at Jombang General Hospitals. The research design was analytic observational with a quantitative approach. Research variables i.e. implementation of EWSS as independent variables. AvLos and trust patients as the dependent variable. The population of this entire research nurses in Inpatient installation at Jombang General Hospitals as much as 135 nurses, patients and families of patients who are being treated in Inpatient installation at Jombang General Hospitals Jombang. Samples taken with the cluster random sampling technique as much as 101 respondents. Data is collected with instruments ceklist and processed in coding, editing, tabulating and scoring as well as tested with logistics regression test. Logistic regression results indicate that partially and simultaneously show that the value of p values < 0.05 so that there were the implementation of Early Warning systems (EWSS) Score against AvLOS and trust of the patient, and the simultaneous influence of 83.2%. The existence of implementation of EWSS in patients with good then early detection and response officers can be done in a proper and effective against the condition and the healing of patients and can shorten the day care patients, so that it can affect the confidence and trust family and patient in receiving health services in the hospital

scholarly journals Data-driven approach to Early Warning Score-based alert management

2018 ◽  
Vol 7 (3) ◽  
pp. e000088 ◽  
Author(s):  
Muge Capan ◽  
Stephen Hoover ◽  
Kristen E Miller ◽  
Carmen Pal ◽  
Justin M Glasgow ◽  
...  
Keyword(s):  
Patient Safety ◽  
Early Warning ◽  
Early Recognition ◽  
Clinical Information ◽  
Patient Characteristics ◽  
The Elderly ◽  
Early Warning Score ◽  
The Right ◽  
The Impact ◽  
Alerting Systems

BackgroundIncreasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.MethodsWe quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure.ResultsWe compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics.ConclusionEWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.

Abstract 9778: Establishing Inter Rater Reliability of the National Early Warning Score (NEWS)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Donna M Miller
Keyword(s):  
Intensive Care ◽  
Acute Care ◽  
Early Warning ◽  
Assessment Tools ◽  
Early Warning Score ◽  
Care Hospital ◽  
Convenience Sample ◽  
Rater Reliability ◽  
National Early Warning Score ◽  
Level Of Agreement

A change in patient condition is a dynamic process which can go unrecognized and result in a failure to rescue. Changes in patients’ vital signs can precede adverse events many hours before critical events such as cardiac arrest or emergent transfer to the Intensive Care Unit occurs. Quantitative assessment tools are used to predict risk and need for additional resources at the bedside. These tools are referred to as Early Warning Scoring Systems. The Royal College of Physicians developed a standardized tool called the National Early Warning Score (NEWS, 2012) that uses a variety of physiologic parameters to assess risk and establish a trigger threshold for summoning additional resources. Purpose: Early warning scoring tools have been found to be reliable and accurate in predicting patient decompensation. However, data from instruments are only as reliable and accurate as the caregiver who obtains and documents the parameters. The purpose of this study was to establish inter rater reliability between the RN and PCA using NEWS. Design, Sample, Setting, Procedures: This study was conducted on the clinical units of a 104 bed Long Term Acute Care Hospital (LTCH) system. These units accept patients directly from Intensive Care Units who require intense services to maintain their trajectory toward recovery. The NEWS provides a way for early detection of patient decompensation which can prevent readmission to acute care and the subsequent financial implications The convenience sample consisted of 22 RNs and 6 PCAs. Consented subjects reviewed an unfolding case study that portrayed a typical patient on the LTCH unit. Subjects were asked to circle the parameter ranges on the NEWS tool that corresponded to physiologic values in the scenario. Findings: Krippendorff’s alpha was utilized to determine the level of agreement among the raters examining the three scenarios. An alpha value of 0.94 was obtained indicating a high level of agreement among the raters. Conclusion: The NEWS can serve as a reliable adjunct to the provision of safe patient care. While it is not the sole source for determining

scholarly journals Early identification of severe community-acquired pneumonia: a retrospective observational study

2019 ◽  
Vol 6 (1) ◽  
pp. e000438 ◽  
Author(s):  
Frances S Grudzinska ◽  
Kerrie Aldridge ◽  
Sian Hughes ◽  
Peter Nightingale ◽  
Dhruv Parekh ◽  
...  
Keyword(s):  
Early Warning ◽  
Assessment Tool ◽  
Characteristic Curve ◽  
Community Acquired Pneumonia ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Early Warning Score ◽  
News Medium ◽  
Increased Risk ◽  
Early Warning Scores

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of sepsis worldwide. Prompt identification of those at high risk of adverse outcomes improves survival by enabling early escalation of care. There are multiple severity assessment tools recommended for risk stratification; however, there is no consensus as to which tool should be used for those with CAP. We sought to assess whether pneumonia-specific, generic sepsis or early warning scores were most accurate at predicting adverse outcomes.MethodsWe performed a retrospective analysis of all cases of CAP admitted to a large, adult tertiary hospital in the UK between October 2014 and January 2016. All cases of CAP were eligible for inclusion and were reviewed by a senior respiratory physician to confirm the diagnosis. The association between the CURB65, Lac-CURB-65, quick Sequential (Sepsis-related) Organ Failure Assessment tool (qSOFA) score and National Early Warning Score (NEWS) at the time of admission and outcome measures including intensive care admission, length of hospital stay, in-hospital, 30-day, 90-day and 365-day all-cause mortality was assessed.Results1545 cases were included with 30-day mortality of 19%. Increasing score was significantly associated with increased risk of poor outcomes for all four tools. Overall accuracy assessed by receiver operating characteristic curve analysis was significantly greater for the CURB65 and Lac-CURB-65 scores than qSOFA. At admission, a CURB65 ≥2, Lac-CURB-65 ≥moderate, qSOFA ≥2 and NEWS ≥medium identified 85.0%, 96.4%, 40.3% and 79.0% of those who died within 30 days, respectively. A Lac-CURB-65 ≥moderate had the highest negative predictive value: 95.6%.ConclusionAll four scoring systems can stratify according to increasing risk in CAP; however, when a confident diagnosis of pneumonia can be made, these data support the use of pneumonia-specific tools rather than generic sepsis or early warning scores.

Early Warning Score Communication Bundle: A Pilot Study

2018 ◽  
Vol 27 (3) ◽  
pp. 238-242
Author(s):  
Cheryl Gagne ◽  
Susan Fetzer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Warning ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Early Warning Scores ◽  
Response Team ◽  
Intensive Care Unit Nurses ◽  
The Impact

Background Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. Objective To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer. Methods After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation. Results Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002). Conclusion Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.

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