Ward post-operative care

2016 ◽  
Author(s):  
Ross Palmer ◽  
Alison Smith
Keyword(s):  
Early Warning ◽  
Early Recognition ◽  
Health Care Team ◽  
Early Warning Score ◽  
Breaking Bad ◽  
Patient Deterioration ◽  
Operative Care ◽  
Policies And Procedures ◽  
Recognition And Response ◽  
Operative Monitoring

Standardized, evidence-based post-operative policies and procedures ensure that safe and effective person-centred care is provided, which is aimed at reducing the likelihood of post-operative complications. Close physiological monitoring is imperative and should incorporate the use of an early warning score such as the National Early Warning Score (NEWS). This ensures early recognition and response to patient deterioration, which is quickly escalated to an appropriate member of the health-care team. This chapter provides an overview of oxygen therapy, wound drains, the removal of sutures and staples, post-operative monitoring, early warning scores, escalation, documentation standards, and breaking bad news.

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.

Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration

PEDIATRICS ◽  
2010 ◽  
Vol 125 (4) ◽  
pp. e763-e769 ◽  
Author(s):  
M. Akre ◽  
M. Finkelstein ◽  
M. Erickson ◽  
M. Liu ◽  
L. Vanderbilt ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning Score ◽  
Patient Deterioration

scholarly journals New Early Warning Score: off-label approach for Covid-19 outbreak patient deterioration in the community

Resuscitation ◽  
2020 ◽  
Vol 151 ◽  
pp. 24-25 ◽  
Author(s):  
Federico Semeraro ◽  
Tommaso Scquizzato ◽  
Andrea Scapigliati ◽  
Giuseppe Ristagno ◽  
Lorenzo Gamberini ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning Score ◽  
Off Label ◽  
Patient Deterioration

scholarly journals Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration*

2019 ◽  
Vol 47 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Armando D. Bedoya ◽  
Meredith E. Clement ◽  
Matthew Phelan ◽  
Rebecca C. Steorts ◽  
Cara O’Brien ◽  
...  
Keyword(s):  
Early Warning ◽  
Best Practice ◽  
Early Warning Score ◽  
Minimal Impact ◽  
Patient Deterioration ◽  
Best Practice Alert

Early warning scores: unravelling detection and escalation

2015 ◽  
Vol 28 (8) ◽  
pp. 872-875 ◽  
Author(s):  
Gary B Smith ◽  
David R Prytherch ◽  
Paul Meredith ◽  
Paul E Schmidt
Keyword(s):  
Early Warning ◽  
Personal Experience ◽  
Design Methodology ◽  
Nurse Educators ◽  
Clinical Care ◽  
Early Warning Score ◽  
Content Type ◽  
Patient Deterioration ◽  
The Difference ◽  
Practical Implications

Purpose – The purpose of this paper is to increase understanding of how patient deterioration is detected and how clinical care escalates when early warning score (EWS) systems are used. Design/methodology/approach – The authors critically review a recent National Early Warning Score paper published in IJHCQA using personal experience and EWS-related publications, and debate the difference between detection and escalation. Findings – Incorrect EWS choice or poorly understood EWS escalation may result in unnecessary workloads forward and responding staff. Practical implications – EWS system implementers may need to revisit their guidance materials; medical and nurse educators may need to expand the curriculum to improve EWS system understanding and use. Originality/value – The paper raises the EWS debate and alerts EWS users that scrutiny is required.

scholarly journals IN-HOSPITAL MORTALITY AND THE PREDICTIVE ABILITY OF THE MODIFIED EARLY WARNING SCORE IN GHANA

2020 ◽  
Author(s):  
Enoch J Abbey ◽  
Jennifer S. Mammen ◽  
Samara E. Soghoian ◽  
Maureen Cadorette ◽  
Promise Ariyo
Keyword(s):  
Early Warning ◽  
Roc Curve ◽  
Predictive Accuracy ◽  
Early Recognition ◽  
Vital Signs ◽  
Objective Measure ◽  
Predictive Ability ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
African Countries

ABSTRACT BACKGROUND The modified early warning score (MEWS) is an objective measure of illness severity that promotes early recognition of clinical deterioration in critically ill patients. Its primary use is to; facilitate faster intervention or increase the level of care. Despite, its adoption in some African countries, MEWS is not standard of care in Ghana. We assessed the validity of MEWS as a predictor of mortality, among medically ill inpatients at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We sought to identify the predictive ability of MEWS in detecting clinical deterioration among medical in-patients and its comparability to the routinely measured vital signs. METHOD This was a retrospective study of medical inpatients, aged >=13 years and admitted at KBTH from January 2017 to March 2019. Vital signs at 48 hours after admission were coded using MEWS criteria, to obtain a limited MEWS score (LMEWS) and the level of consciousness imputed to obtain a full MEWS score (MEWS). A predictive model comparing mortality among patients with significant MEWS (L/MEWS >=4) and non-significant MEWS (L/MEWS <4) scores was designed using multiple logistic regression. Internally validated for predictive accuracy, using the Receiver Operating Characteristic (ROC) curve. RESULTS 112 patients were included in the study. The adjusted odds of death comparing patients with a significant MEWS to patients with non-significant MEWS was 6.33(95% CI 1.96 to 20.48). Similarly, the adjusted odds of death comparing patients with significant versus non-significant LMEWS was 8.22(95% CI 2.45 to 27.56). The ROC curve for each analysis had a C static of 0.83 and 0.84 respectively. CONCLUSION LMEWS is a good predictor of mortality and comparable to MEWS. Adoption of LMEWS can identify medical in-patients at risk of deterioration and death.

scholarly journals Validation of the Pediatric Early Warning Score to determine patient deterioration from illness

2016 ◽  
Vol 56 (4) ◽  
pp. 251 ◽  
Author(s):  
Lenny Elita ◽  
Silvia Triratna ◽  
Erial Bahar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Early Warning ◽  
Roc Curve ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Early Warning Score ◽  
Intensive Care Unit Treatment ◽  
Patient Deterioration

Background Patients who enter the emergency room (ERER) present with a variety of conditions, ranging from mild to critical. As such, it may be hard to determine which patients are in need of intensive care unit treatment. The Pediatric Early Warning Score (PEWS) has been used to identify signs of critical illness in pediatric patients.Objective To validate the PEWS system for assessing signs of critical illness in pediatric patients at Dr. Mohammad Hoesin Hospital, Palembang.Methods Subjects were children aged 1 month to 18 years who received treatment in the ERER and Pediatrics Ward inDr. Mohammad Hoesin Hospital in March to April 2015. Assessment with PEWS was based on vital sign examinations. Scores ranged from 0 to 9. The PEWS was generally taken twice, first in the ER , then after 6 hours in the ward. We obtained the cut-off point, sensitivity, and specificity of PEWS, in terms of need for pediatric intensive care unit (PICU) treatment.Results One hundred fifty patients were included in this study. Patients with PEW score of 5 or greater in the ER were relatively more likely to be transferred to the PICU, with a sensitivity of 94.4% and a specificity of 82.5%. The cut-off point obtained from the ROC curve was score 4.5 with AUC 96.7% (95%CI 93.4 to 99.9%; P<0.001).Conclusion A PEWS score of cut-off ≥5 may be used to determine which patients are in critically ill condition requiring treatment in PICU.

scholarly journals The Ability of Early Warning Scores to Predict in Hospital Mortality and ICU Admission for Patients with Covid 19 Pneumonia in the Emergency Department

2021 ◽  
Author(s):  
Yunus Arik ◽  
Hatice Topçu ◽  
Mustafa Altınay
Keyword(s):  
Emergency Department ◽  
Early Warning ◽  
Early Recognition ◽  
Demographic Data ◽  
Scoring Systems ◽  
Early Warning Score ◽  
Youden Index ◽  
Icu Admission ◽  
Admission Rates ◽  
Diagnostic Values

Introduction: Early recognition of critical patients in crowded environments such as emergency departments is required in Covid 19 pandemic and many early recognition scoring systems are used. In this study, we aimed to determine the prognostic values of these scoring systems. Material and method: This retrospective study was performed between March 2020 -May 2020 and 212 patient who have Covid 19 pneumonia were enrolled the study. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment (qSOFA) scores were calculated at the time of admission to the emergency department. Demographic data, mortality, intensive care unit (ICU) admission rates and the prognostic values of the scores were calculated. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic values of scores and the optimum cut-off values were determined by using Youden Index. Results: 23 (10.8%) of 212 patients died and 34 (16%) were admitted to ICU. The AUC values of MEWS, NEWS, and qSOFA for predicting mortality in < 65 years old were 0.852 (95% confidence interval 0.708-0.997), 0.882(0.741-1.000) and 0.879(0.768-0.990) and >65 years old, 0.854(0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) respectively. For ICU admission AUC values of MEWS, NEWS and qSOFA in <65 years old followed as; 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) and 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) in ≥ 65 years old. While < 65 years old; MEWS and qSOFA’s optimal cut-off values for mortality were ≥2 with %90.0 sensitivity %74.7 specificity and ≥1 with %90.0 sensitivity %74.7 specificity, for ≥ 65 years NEWS optimal cut-off is ≥6 with 91.7% sensitivity and 76.7% specificity. Conclusion: All these three scores have good predictive value for mortality and ICU admission, but NEWS is better than MEWS and qSOFA especially in ≥ 65 years old patient with Covid 19 pneumonia.

scholarly journals Nurses' Experiences and Perceptions of two Early Warning Score systems to Identify Patient Deterioration—A Focus Group Study

Nursing Open ◽  
2021 ◽  
Author(s):  
Caroline S. Langkjaer ◽  
Dorthe G. Bove ◽  
Pernille B. Nielsen ◽  
Kasper K. Iversen ◽  
Morten H. Bestle ◽  
...  
Keyword(s):  
Focus Group ◽  
Early Warning ◽  
Early Warning Score ◽  
Focus Group Study ◽  
Patient Deterioration ◽  
Score Systems
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