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

International Journal of Emergency Medicine

Volumn 7, Issue 1, 2014, Pages

  Correia, Nuno ^a   Rodrigues, Rui Paulo ^b   Sá, Márcia Carvalho ^c   Dias, Paula ^b   Lopes, Luís ^b   Paiva, Artur ^b,d  

^a Institute of Biomedical Sciences Abel Salazar   (Portugal)

^b Universidade do Porto   (Portugal)

^c Primary Healthcare Unit Saúde em Família   (Portugal)

^d University of Porto   (Portugal)

Author keywords

Early warning score; Emergency; Track and trigger; Triage

Indexed keywords

ADULT; AGED; ARTICLE; EARLY WARNING SCORE; FEMALE; GENERAL CONDITION DETERIORATION; GENERAL HOSPITAL; HEALTH SERVICE; HIGH RISK PATIENT; HOSPITAL PATIENT; HUMAN; INTENSIVE CARE UNIT; LENGTH OF STAY; MAJOR CLINICAL STUDY; MALE; MORTALITY; NURSING HOME; OBSERVATIONAL STUDY; OUTCOME ASSESSMENT; PATIENT ASSESSMENT; PATIENT IDENTIFICATION; PORTUGAL; PRIORITY JOURNAL; RESPIRATORY TRACT DISEASE; RETROSPECTIVE STUDY; RISK ASSESSMENT; SCORING SYSTEM; VITAL SIGN; WARD;

EID: 84904446904     PISSN: 18651372     EISSN: 18651380     Source Type: Journal    
DOI: 10.1186/s12245-014-0022-7     Document Type: Article

References (40)

1. Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL: Clinical antecedents to in-hospital cardiopulmonary arrest.Chest 1990, 98(6):1388–1392.
2. Franklin C, Mathew J: Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event.Crit Care Med 1994, 22(2):244–247.
3. Goldhill DR, McNarry AF, Mandersloot G, McGinley A: A physiologically-based early warning score for ward patients: the association between score and outcome.Anaesthesia 2005, 60(6):547–553.
4. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K: A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom–the ACADEMIA study.Resuscitation 2004, 62(3):275–282.
5. Jacques T, Harrison GA, McLaws ML, Kilborn G: Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the inpatient setting.Resuscitation 2006, 69(2):175–183.
6. Watkinson PJ, Barber VS, Price JD, Hann A, Tarassenko L, Young JD: A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients.Anaesthesia 2006, 61(11):1031–1039.
7. Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J: Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital.Med J Aust 1999, 171(1):22–25.
8. Rivers EP, Coba V, Whitmill M: Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature.Curr Opin Anaesthesiol 2008, 21(2):128–140.
9. Fresco C, Carinci F, Maggioni AP, Ciampi A, Nicolucci A, Santoro E, Tavazzi L, Tognonia G: Very early assessment of risk for in-hospital death among 11,483 patients with acute myocardial infarction. GISSI investigators.Am Heart J 1999, 138(6 Pt 1):1058–1064.
10. Morgan RJ, Wright MM: In defence of early warning scores.Br J Anaesth 2007, 99(5):747–748.
11. Gao H, McDonnell A, Harrison DA, Moore T, Adam S, Daly K, Esmonde L, Goldhill DR, Parry GJ, Rashidian A, Subbe CP, Harvey S: Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward.Intensive Care Med 2007, 33(4):667–679.
12. Jones DA, DeVita MA, Bellomo R: Rapid-response teams.N Engl J Med 2011, 365(2):139–146.
13. Saude D-G: Criacao e implementacao de uma Equipa de Emergencia Medica Intra-Hospitalar (EEMI), Circular No15/DQS/DQCQ. Direccao-geral de Saude, 2010. [cited 2010 22nd December 2011]; Available from: http://www.dgs.pt.
14. Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerbach A, Chen WJ, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milbrandt E, Peberdy M, Savitz L, Young L, Harvey M, Galhotra S: Findings of the first consensus conference on medical emergency teams.Crit Care Med 2006, 34(9):2463–2478.
15. Morgan RJM, Williams F, Wright MM: An early warning scoring system for detecting developing critical illness.Clin Intensive Care 1997, 8:100.
16. Subbe CP, Kruger M, Rutherford P, Gemmel L: Validation of a modified early warning score in medical admissions.QJM 2001, 94(10):521–526.
17. Burch VC, Tarr G, Morroni C: Modified early warning score predicts the need for hospital admission and inhospital mortality.Emerg Med J 2008, 25(10):674–678.
18. Groarke JD, Gallagher J, Stack J, Aftab A, Dwyer C, McGovern R, Courtney G: Use of an admission early warning score to predict patient morbidity and mortality and treatment success.Emerg Med J 2008, 25(12):803–806.
19. Robb G, Seddon M: A multi-faceted approach to the physiologically unstable patient.Qual Saf Health Care 2010, 19(5):e47.
20. Adam S, Odell M: An acute problem? A report of the National Confidential Enquiry into Patient Outcome and Death.Nurs Crit Care 2005, 10(5):225–227.
21. McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, Nielsen M, Barrett D, Smith G, Collins CH: Confidential inquiry into quality of care before admission to intensive care.BMJ 1998, 316(7148):1853–1858.
22. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A, MERIT study investigators: Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial.Lancet 2005, 365(9477):2091–2097.
23. Leuvan CH, Mitchell I: Missed opportunities? An observational study of vital sign measurements.Crit Care Resusc 2008, 10(2):111–115.
24. Cretikos MA, Bellomo R, Hillman K, Chen J, Finfer S, Flabouris A: Respiratory rate: the neglected vital sign.Med J Aust 2008, 188(11):657–659.
25. Goldhill DR, White SA, Sumner A: Physiological values and procedures in the 24 h before ICU admission from the ward.Anaesthesia 1999, 54(6):529–534.
26. Cretikos M, Chen J, Hillman K, Bellomo R, Finfer S, Flabouris A: The objective medical emergency team activation criteria: a case-control study.Resuscitation 2007, 73(1):62–72.
27. McBride J, Knight D, Piper J, Smith GB: Long-term effect of introducing an early warning score on respiratory rate charting on general wards.Resuscitation 2005, 65(1):41–44.
28. Albino AP, Jacinto V: Implementation of an Early Warning Score. 2009. Available from: http://www.chbalgarvio.min-saude.pt/NR/rdonlyres/B85D81E0-0C79-426E-9930-6CED2DFD0F7E/22432/artigo_EWS_final.pdf.
29. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI, Kellett J, Deane B, Higgins B: Should age be included as a component of track and trigger systems used to identify sick adult patients?Resuscitation 2008, 78(2):109–115.
30. Bell CM, Redelmeier DA: Mortality among patients admitted to hospitals on weekends as compared with weekdays.N Engl J Med 2001, 345(9):663–668.
31. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, Meaney PA, Cen L, Nadkarni VM, Praestgaard AH, Berg RA, National Registry of Cardiopulmonary Resuscitation Investigators: Survival from in-hospital cardiac arrest during nights and weekends.JAMA 2008, 299(7):785–792.
32. Sea L: Variacao na mortalidade e na demora media do internamento por dia de admissao e de alta.Rev Port Saude Publ 2008, 7:117–129.
33. Gardner-Thorpe J, Love N, Wrightson J, Walsh S, Keeling N: The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study.Ann R Coll Surg Engl 2006, 88(6):571–575.
34. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M: Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards.Cochrane Database Syst Rev 2007, 3:CD005529.
35. Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L: Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions.Anaesthesia 2003, 58(8):797–802.
36. Cei M, Bartolomei C, Mumoli N: In-hospital mortality and morbidity of elderly medical patients can be predicted at admission by the Modified Early Warning Score: a prospective study.Int J Clin Pract 2009, 63(4):591–595.
37. Maupin JM, Roth DJ, Krapes JM: Use of the Modified Early Warning Score decreases code blue events.Jt Comm J Qual Patient Saf 2009, 35(12):598–603.
38. de Pennington J, Laurenson J, Lebus C, Sihota S, Smith P: Evaluation of early warning systems on a medical admissions unit.JICS 2005, 6:19–21.
39. Duckitt RW, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, Forni LG: Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study.Br J Anaesth 2007, 98(6):769–774.
40. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI, Higgins B: A review, and performance evaluation, of single-parameter “track and trigger” systems.Resuscitation 2008, 79(1):11–21.