Into the night: factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement
Yiu, C.J.; Khan, S.U.; Subbe, C.P.; Tofeec, K.; Madge, R.A.
Acute Medicine 13(2): 56-60
2014
ISSN/ISBN: 1747-4884 PMID: 24940567 Document Number: 13200
Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care. To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff. Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts. During 2360 observed bed days 109 patients triggered NEWS>=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS>=6 had lower escalation rates. Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.
Document emailed within 1 workday
