National early warning score (NEWS) – evaluation in surgery

2015 ◽  
Vol 28 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Peter M Neary ◽  
Mark Regan ◽  
Myles J Joyce ◽  
Oliver J McAnena ◽  
Ian Callanan
Keyword(s):  
Patient Outcome ◽  
Improve Patient Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Content Type ◽  
Response Team ◽  
National Early Warning Score ◽  
The Impact ◽  
Improve Patient

Purpose – The purpose of this paper is to evaluate staff opinion on the impact of the National Early Warning Score (NEWS) system on surgical wards. In 2012, the NEWS system was introduced to Irish hospitals on a phased basis as part of a national clinical programme in acute care. Design/methodology/approach – A modified established questionnaire was given to surgical nursing staff, surgical registrars, surgical senior house officers and surgical interns for completion six months following the introduction of the NEWS system into an Irish university hospital. Findings – Amongst the registrars, 89 per cent were unsure if the NEWS system would improve patient care. Less than half of staff felt consultants and surgical registrars supported the NEWS system. Staff felt the NEWS did not correlate well clinically with patients within the first 24 hours (Day zero) post-operatively. Furthermore, 78-85 per cent of nurses and registrars felt a rapid response team should be part of the escalation protocol. Research limitations/implications – Senior medical staff were not convinced that the NEWS system may improve patient care. Appropriate audit proving a beneficial impact of the NEWS system on patient outcome may be essential in gaining support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward. Originality/value – Appropriate audit of the impact of the NEWS system on patient outcome may be pertinent to obtain the support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward.

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.

scholarly journals National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Joonas Tirkkonen ◽  
Sari Karlsson ◽  
Markus B. Skrifvars
Keyword(s):  
Observational Study ◽  
Early Warning ◽  
Prospective Observational Study ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Hospital Death ◽  
Hospital Patient ◽  
Response Team ◽  
National Early Warning Score

Abstract Background The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. Methods We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. Results The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively. Conclusions We found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

National Early Warning Score vs Rapid Response Team criteria-Prevalence, misclassification, and outcome

2018 ◽  
Vol 63 (2) ◽  
pp. 215-221 ◽  
Author(s):  
Ola Friman ◽  
Max Bell ◽  
Therese Djärv ◽  
Andreas Hvarfner ◽  
Gabriella Jäderling
Keyword(s):  
Early Warning ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Response Team ◽  
National Early Warning Score

Improved outcomes after implementation of a specialized pediatric cardiac rapid response team

2021 ◽  
pp. 1-7
Author(s):  
Angela S. McKeta ◽  
Anthony M. Hlavacek ◽  
Shahryar M. Chowdhury ◽  
Mark Scheurer ◽  
Eric M. Graham ◽  
...  
Keyword(s):  
Improve Patient Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Interdisciplinary Care ◽  
Arrest Rate ◽  
Cardiac Intensive Care Unit ◽  
Improved Outcomes ◽  
Response Team ◽  
Cardiac Intensive Care ◽  
Improve Patient

Abstract Introduction: The efficacy of a specialized pediatric cardiac rapid response team is unknown. We hypothesized that a specialized cardiac rapid response team would facilitate team-wide communication between the cardiac stepdown unit and cardiac intensive care unit (ICU) teams and improve patient care. Materials and methods: A specialized pediatric cardiac rapid response team was implemented in June 2015. All pediatric cardiac rapid response team activations and outcomes from implementation through December 2018 were reviewed. Cardiac arrests and unplanned transfers to the cardiac ICU were indexed to 1000 patient-days to account for inpatient volume trends and evaluated over time. Results: There were 202 cardiac rapid response team activations in 108 unique patients during the study period. After implementation of the pediatric cardiac rapid response team, unplanned transfers from the cardiac stepdown unit to the cardiac ICU decreased from 16.8 to 7.1 transfers per 1000 patient days (p = 0.012). The stepdown unit cardiac arrest rate decreased from 1.2 to 0.0 arrests per 1000 patient-days (p = 0.015). There was one death on the cardiac stepdown unit in the 5 years since the implementation of the cardiac rapid response team, compared to four deaths in the previous 5 years. Conclusions: A reduction in unplanned cardiac ICU transfers, cardiac arrests, and mortality on the cardiac stepdown unit has been observed since the implementation of a specialized pediatric cardiac rapid response team. A specialized cardiac rapid response team may improve communication and empower the interdisciplinary care team to escalate care for patients experiencing clinical decline.

scholarly journals Reduced frequency of cardiopulmonary arrests by rapid response teams

2012 ◽  
Vol 10 (4) ◽  
pp. 442-448 ◽  
Author(s):  
Paulo David Scatena Gonçales ◽  
Joyce Assis Polessi ◽  
Lital Moro Bass ◽  
Gisele de Paula Dias Santos ◽  
Paula Kiyomi Onaga Yokota ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Rapid Response Team ◽  
Rapid Response ◽  
High Complexity ◽  
Rapid Response Teams ◽  
Cardiorespiratory Arrest ◽  
Reduced Frequency ◽  
Before And After ◽  
Response Team ◽  
The Impact

OBJECTIVE: To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS: A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS: During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p<0.001) and 14.34 deaths/1,000 discharges (p=0.029). CONCLUSION: The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

Addition of Acute Care Nurse Practitioners to Medical and Surgical Rapid Response Teams: A Pilot Project

2014 ◽  
Vol 34 (1) ◽  
pp. 51-59 ◽  
Author(s):  
April N. Kapu ◽  
Arthur P. Wheeler ◽  
Byron Lee
Keyword(s):  
Acute Care ◽  
Nurse Practitioners ◽  
Rapid Response Team ◽  
Pilot Project ◽  
Rapid Response ◽  
Therapeutic Interventions ◽  
Rapid Response Teams ◽  
Care Nurse ◽  
Response Team ◽  
The Impact

BackgroundVanderbilt University Hospital’s original rapid response team included a critical care charge nurse and a respiratory therapist. A frequently identified barrier to care was the time delay between arrival of the rapid response team and arrival of the primary health care team.ObjectiveTo assess the impact of adding an acute care nurse practitioner to the rapid response team.MethodsAcute care nurse practitioners were added to surgical and medical rapid response teams in January 2011 to diagnose and order treatments on rapid response calls.ResultsIn 2011, the new teams responded to 898 calls, averaging 31.8 minutes per call. The most frequent diagnoses were respiratory distress (18%), postoperative pain (13%), hypotension (12%), and tachyarrhythmia (10%). The teams facilitated 360 transfers to intensive care and provided 3056 diagnostic and therapeutic interventions. Communication with the primary team was documented on 97% of the calls. Opportunities for process improvement were identified on 18% of the calls. After implementation, charge nurses were surveyed, with 96% expressing high satisfaction associated with enhanced service and quality.ConclusionsTeams led by nurse practitioners provide diagnostic expertise and treatment, facilitation of transfers, team communication, and education.

Improving Patient Safety through the Use of Nursing Surveillance

2017 ◽  
Vol 51 (s2) ◽  
pp. 34-43 ◽  
Author(s):  
Karen K. Giuliano
Keyword(s):  
Patient Care ◽  
Clinical Care ◽  
Warning System ◽  
Rapid Response Team ◽  
Hospital Length ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
Clinical Implications ◽  
Response Team ◽  
The Impact

Surveillance and monitoring each represent a distinct process in patient care. Monitoring involves observation, measurement, and recording of physiological parameters, while surveillance is a systematic, goal-directed process based on early detection of signs of change, interpretation of the clinical implications of such changes, and initiation of rapid, appropriate interventions. Through use of an illustrative clinical example based on Early Warning System scoring and rapid response teams, this article seeks to distinguish between nurse monitoring and surveillance to demonstrate the impact of surveillance on improving both care processes and patient care. Using a clinical example, differences between surveillance and monitoring as a trigger for deployment of the rapid response team were reviewed. The use of surveillance versus monitoring resulted in a mean reduction in rapid response team deployment time of 291 minutes. The median hospital length of stay for patients whose clinical care included using surveillance to initiate the deployment of the rapid response team was reduced by 4 days. Monitoring relies on observation and assessment while nursing surveillance incorporates monitoring with recognition and interpretation of the clinical implications of changes to guide decisions about subsequent actions. The clinical example described here supports that the use of an automated surveillance system versus monitoring had a measurable impact on clinical care.

scholarly journals The Impact of Rapid Response Team Activation on Unplanned Transfers to the ICU

2021 ◽  
Author(s):  
Erica Nelson
Keyword(s):  
Systematic Review ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Healthcare Improvement ◽  
Number Of Patients ◽  
Pubmed Database ◽  
Response Team ◽  
Hospital Morbidity ◽  
Unplanned Admissions ◽  
The Impact

Rapid Response Teams (RRTs) were addressed by the Institute for Healthcare Improvement (IHI) as a means for improving inpatient hospital morbidity and mortality. There implementation was encouraged nationwide with the goal to decrease inpatient cardiopulmonary arrests, mortality rates and unplanned admissions to the Intensive Care Unit (ICU). The purpose of this systematic review was to evaluate the impact of RRTs on unplanned transfers to the ICU. A comprehensive literature review was performed using the PubMed database focusing on RRTs and unplanned ICU transfers. The Donabedian model was used as the theory for this review in conjunction with the PRISMA framework. Study specific data and data outcomes were extracted from individual studies and recorded in tables. Critical appraisal of the included studies was performed utilizing the CASP Checklist for cohort studies. Cross study analysis was then performed to compare outcomes of individual studies against one another in the form of a table. The findings of this systematic review addressed the impact of RRT on ICU admissions with varying outcomes in regards to number of patients admitted to the ICU after RRT review, APACHE scores, length of stay, and mortality. Results of this study address limitations of the identified research and recommendations and implications for the role of the advanced practice nurse.

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