Limits...
Improving recognition of patients at risk in a Portuguese general hospital: results from a preliminary study on the early warning score.

Correia N, Rodrigues RP, Sá MC, Dias P, Lopes L, Paiva A - Int J Emerg Med (2014)

Bottom Line: EWS systems are not widely used in Portuguese health service.Clinical worsening, lengths of stay, admission into high care units, and mortality may be predicted by the EWS.Prospective studies with multivariable analysis are needed to clarify the global outcome of the EWS implementation in national wards.

View Article: PubMed Central - HTML - PubMed

Affiliation: Emergency Service, University Hospital - Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal.

ABSTRACT

Background: Early warning score (EWS) is a system that assists in the timely recognition of hospitalized patients outside critical care areas with potential or established critical illness at risk of deteriorating and who may be receiving suboptimal care. No such systems have been implemented in Portuguese National Health Service's wards. We performed a preliminary study to assess the potential outcome of applying the EWS in our hospital setting.

Methods: An observational retrospective study was conducted based on 100 patients assessed by the outreach team due to an acute event. The EWS was calculated a posteriori on three preceding periods from the acute deterioration (-12, -24, and -72 h).

Results: In 35 patients, there was insufficient recording of vital signs. The final sample of 65 patients includes 62.0% men, and the mean age (±SD) was 67 ± 16 years old. Respiratory problems were the main cause of deterioration (44.6%). The EWS score increased from -72 to -12 h. More than half of cases (63.0%) were admitted into high care units, and their mean (±SD) score was higher in comparison to those remaining in general wards (Intermediate Care Units 3.75 ± 1.9, Intensive Care Units 4.2 ± 1.5, wards 3.5 ± 1.4). Score at -24 and -12 h seemed to predict length of stay (LoS; p < 0.05) and mortality, respectively. The EWS would have incremented early medical attention by 40.0% if a threshold of ≥3 was used.

Conclusions: EWS systems are not widely used in Portuguese health service. Our data suggests that the EWS would allow early recognition for a higher number of patients in comparison to current ward care. Clinical worsening, lengths of stay, admission into high care units, and mortality may be predicted by the EWS. Prospective studies with multivariable analysis are needed to clarify the global outcome of the EWS implementation in national wards.

No MeSH data available.


Related in: MedlinePlus

Graphs showing progressive increase in scores toward the moment of acute deterioration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4306038&req=5

Figure 2: Graphs showing progressive increase in scores toward the moment of acute deterioration.

Mentions: A progressive increase in scores as approaching to the moment of acute deterioration was documented in three studied periods (Figure 2).


Improving recognition of patients at risk in a Portuguese general hospital: results from a preliminary study on the early warning score.

Correia N, Rodrigues RP, Sá MC, Dias P, Lopes L, Paiva A - Int J Emerg Med (2014)

Graphs showing progressive increase in scores toward the moment of acute deterioration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4306038&req=5

Figure 2: Graphs showing progressive increase in scores toward the moment of acute deterioration.
Mentions: A progressive increase in scores as approaching to the moment of acute deterioration was documented in three studied periods (Figure 2).

Bottom Line: EWS systems are not widely used in Portuguese health service.Clinical worsening, lengths of stay, admission into high care units, and mortality may be predicted by the EWS.Prospective studies with multivariable analysis are needed to clarify the global outcome of the EWS implementation in national wards.

View Article: PubMed Central - HTML - PubMed

Affiliation: Emergency Service, University Hospital - Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal.

ABSTRACT

Background: Early warning score (EWS) is a system that assists in the timely recognition of hospitalized patients outside critical care areas with potential or established critical illness at risk of deteriorating and who may be receiving suboptimal care. No such systems have been implemented in Portuguese National Health Service's wards. We performed a preliminary study to assess the potential outcome of applying the EWS in our hospital setting.

Methods: An observational retrospective study was conducted based on 100 patients assessed by the outreach team due to an acute event. The EWS was calculated a posteriori on three preceding periods from the acute deterioration (-12, -24, and -72 h).

Results: In 35 patients, there was insufficient recording of vital signs. The final sample of 65 patients includes 62.0% men, and the mean age (±SD) was 67 ± 16 years old. Respiratory problems were the main cause of deterioration (44.6%). The EWS score increased from -72 to -12 h. More than half of cases (63.0%) were admitted into high care units, and their mean (±SD) score was higher in comparison to those remaining in general wards (Intermediate Care Units 3.75 ± 1.9, Intensive Care Units 4.2 ± 1.5, wards 3.5 ± 1.4). Score at -24 and -12 h seemed to predict length of stay (LoS; p < 0.05) and mortality, respectively. The EWS would have incremented early medical attention by 40.0% if a threshold of ≥3 was used.

Conclusions: EWS systems are not widely used in Portuguese health service. Our data suggests that the EWS would allow early recognition for a higher number of patients in comparison to current ward care. Clinical worsening, lengths of stay, admission into high care units, and mortality may be predicted by the EWS. Prospective studies with multivariable analysis are needed to clarify the global outcome of the EWS implementation in national wards.

No MeSH data available.


Related in: MedlinePlus