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.

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.

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 Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons (Preprint)

2020 ◽  
Author(s):  
Mathilde van Rossum ◽  
Jobbe Leenen ◽  
Feike Kingma ◽  
Martine Breteler ◽  
Richard van Hillegersberg ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Early Recognition ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Situational Factors ◽  
Vital Signs Monitoring ◽  
Surgical Ward ◽  
The Impact

BACKGROUND Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. OBJECTIVE This study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. METHODS Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. RESULTS The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. CONCLUSIONS Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.

The impact of the use of the Early Warning Score (EWS) on patient outcomes: A systematic review

Resuscitation ◽  
2014 ◽  
Vol 85 (5) ◽  
pp. 587-594 ◽  
Author(s):  
N. Alam ◽  
E.L. Hobbelink ◽  
A.J. van Tienhoven ◽  
P.M. van de Ven ◽  
E.P. Jansma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Early Warning ◽  
Early Warning Score ◽  
The Impact

scholarly journals The Niguarda MEWS, a new and refined tool to determine criticality and instability in Internal Medicine Ward and Emergency Medicine Unit

2017 ◽  
Vol 11 (3) ◽  
pp. 310
Author(s):  
Fabrizio Colombo ◽  
Lucia Taurino ◽  
Giulia Colombo ◽  
Massimo Amato ◽  
Salvatore Rizzo ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Early Warning ◽  
Primary Outcome ◽  
Area Under The Curve ◽  
Warning System ◽  
Early Warning Score ◽  
Secondary Outcome ◽  
Internal Medicine Ward ◽  
Level Of Consciousness ◽  
The Right

This study compares the effect of the modified early warning score (MEWS) <em>versus</em> a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca’ Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care.

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 The Ergonomics of the Islamic Ablution: Exploring Considerations for the Elderly in the Mosque

2020 ◽  
Vol 2 (1) ◽  
pp. 59-77
Author(s):  
Sarah Aliya Che Hasbi ◽  
Sufian Hamat
Keyword(s):  
The Elderly ◽  
Practical Experience ◽  
General Observation ◽  
Design Assessment ◽  
The People ◽  
Current Design ◽  
Physical Abilities ◽  
And Performance ◽  
The Right ◽  
The Impact

A general observation on the state and condition of the ablution area at some mosques in the country has pictured the place as slippery and unsafe and not properly used and maintained.  This has led to the assumptions that the design of the place had not thoroughly considered the ergonomic factors and right anthropometric of the users which has created discomfort in positioning oneself and accessing the fixtures during the act.  The impact of the problems has never been rationalized and always overlooked particularly on how it may affect the elderly group that is has become very common and being repeated in the provision of the ablution area in other mosque’s design and development.  In consideration of the pressing issues and needs for an appropriate ablution area as part of safety and cleanliness measures at Mosque or Surau, the design of the facility must be emphasized and be based on the needs and physical abilities of the users. This particular study on the ablution area is necessary as it has uncovered salient and common problem of the current design of the place.  The methodology selected for the study was a combination of several methods.  It encompassed onsite observation on the practical use and performance of the ablution area, interview survey on users’ practical experience and design assessment focusing on the ergonomic and anthropometric considerations of the place through measured drawing method.  The results were triangulated to determine the overall performance of the present design of ablution area in facilitating spiritual obligation of the people. For the purpose, three different mosques in Kuala Nerus district namely Masjid UNiSZA (Universiti Sultan Zainal Abidin), Masjid UMT (Universiti Malaysia Terengganu) and Masjid Tok Jembal were selected as case studies. The study on the 3 sites of ablution area has displayed results indicating problems generally based on the location and proximity of water faucet and seating provision at the area which apparently were not based on the right ergonomic. This has created discomfort to the users and leaving messy and slippery ground after use.

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