Case: Early Warning Score System
Wellington Hospital recently introduced an Early Warning Score (EWS) system that triggers a review of sick patients by more senior nursing or medical staff based on their 'vital signs' (blood pressure, pulse rate, breathing rate etc).
The sicker the patient, the higher the EWS. Each vital sign has a weighting assigned to different values (e.g. a pulse rate of 40-49 is assigned an EWS of 3) which are then added up to a combined EWS which is used to trigger a system response. This system has been proven to reduce in hospital cardiac arrests and to bring the necessary expertise to deteriorating patients in a rapid fashion. It is well documented in the medical literature that there is a system-wide failure to detect deteriorating patients & even if this is recognised by junior staff, the escalation of expertise is often not activated for various practical & political reasons. At present the EWS is assessed using a colour-coded observation chart (see appendix) which relies on the bedside nurse to perform & document the observation on the chart, calculate the score correctly according to the correct colour-banded zone & then to follow a protocol to contact the necessary person (nurse in charge, junior doctor, senior doctor, medical emergency team etc). The system fails the patient if the EWS is incorrectly scored and added up, or the escalation protocol is not followed. My suggestion is for a hand-held portable device (PDA or Smartphone) into which the nurse enters the observations as he/she is doing them (via a simplistic drop-down menu).
These are then transmitted wirelessly to a central location on the ward where they are collected and stored & can be examined by anyone without having to find the individual patient's physical paper vital signs chart. More importantly, the score matrix is applied, the EWS calculated, and the correct person(s) is/are notified by pager/text message automatically according to the total score. This automatic correct notification and escalation of care for sicker patients removes human factors from the escalation system, bringing expertise to the bedside of deteriorating patients. We know from admissions to our Intensive Care Unit that the system fails when the incorrect observation chart is used or the EWS is either not calculated or calculated incorrectly. I believe this system will automate data collection allowing a formidable dataset to be collected for study, but more importantly has major patient safety implications.
