Implementation of an automated early warning scoring system in a surgical ward: Practical use and effects on patient outcomes

PLoS One. 2019 May 8;14(5):e0213402. doi: 10.1371/journal.pone.0213402. eCollection 2019.

Abstract

Introduction: Early warning scores (EWS) are being increasingly embedded in hospitals over the world due to their promise to reduce adverse events and improve the outcomes of clinical patients. The aim of this study was to evaluate the clinical use of an automated modified EWS (MEWS) for patients after surgery.

Methods: This study conducted retrospective before-and-after comparative analysis of non-automated and automated MEWS for patients admitted to the surgical high-dependency unit in a tertiary hospital. Operational outcomes included number of recorded assessments of the individual MEWS elements, number of complete MEWS assessments, as well as adherence rate to related protocols. Clinical outcomes included hospital length of stay, in-hospital and 28-day mortality, and ICU readmission rate.

Results: Recordings in the electronic medical record from the control period contained 7929 assessments of MEWS elements and were performed in 320 patients. Recordings from the intervention period contained 8781 assessments of MEWS elements in 273 patients, of which 3418 were performed with the automated EWS system. During the control period, 199 (2.5%) complete MEWS were recorded versus 3991 (45.5%) during intervention period. With the automated MEWS systems, the percentage of missing assessments and the time until the next assessment for patients with a MEWS of ≥2 decreased significantly. The protocol adherence improved from 1.1% during the control period to 25.4% when the automated MEWS system was involved. There were no significant differences in clinical outcomes.

Conclusion: Implementation of an automated EWS system on a surgical high dependency unit improves the number of complete MEWS assessments, registered vital signs, and adherence to the EWS hospital protocol. However, this positive effect did not translate into a significant decrease in mortality, hospital length of stay, or ICU readmissions. Future research and development on automated EWS systems should focus on data management and technology interoperability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Early Warning Score*
  • Female
  • Hospital Units*
  • Humans
  • Intensive Care Units
  • Male
  • Medical Informatics / methods*
  • Middle Aged
  • Patient Outcome Assessment
  • Practice Patterns, Physicians'
  • Retrospective Studies
  • Surgery Department, Hospital*

Associated data

  • Dryad/10.5061/dryad.000mn47

Grants and funding

The sponsor of this study was the Catharina Hospital. The study is a part of PhD research focusing on perioperative monitoring within a collaboration project of the Catharina Hospital, Technical University Eindhoven and Philips Research (IMPULS 2). Authors Rick Bezemer (RB) and Louis Atallah (LA) are employees of Philips Research and were only involved in the preparation of the study design and the manuscript. Dr. R.A. Bouwman and H.H.M. Korsten have acted as clinical consultants for Philips Research in Eindhoven, the Netherlands. R.A. Bouwman is also a member of the associate editorial board of the British Journal of Anaesthesia and received travel support from CSLBehring to visit Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) 2015. URL to the sponsors’ website is https://www.catharinaziekenhuis.nl/.