Strengths and limitations of early warning scores: A systematic review and narrative synthesis

International Journal of Nursing Studies

Volumn 76, Issue , 2017, Pages 106-119

  Downey, C L ^a   Tahir, W ^a   Randell, R ^a   Brown, J M ^b   Jayne, D G ^a  

^a UNIVERSITY OF LEEDS   (United Kingdom)

^b UNIVERSITY OF LEEDS   (United Kingdom)

Author keywords

Early warning scores; Limitations; Strengths; Systematic review; Vital signs

Indexed keywords

ADULT; AUTOMATION; CHILD; CINAHL; CLINICAL OUTCOME; COCHRANE LIBRARY; DECISION MAKING; DETERIORATION; FACILITATION; FEMALE; HUMAN; LANGUAGE; MALE; MEDLINE; MONITORING; NARRATIVE; PATIENT CARE; PATIENT SAFETY; PREDICTION; PREDICTIVE VALUE; SYNTHESIS; SYSTEMATIC REVIEW; VALIDATION PROCESS; VITAL SIGN; VERBAL COMMUNICATION;

HUMANS; NARRATION; PATIENT SAFETY; VITAL SIGNS;

EID: 85029693202     PISSN: 00207489     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ijnurstu.2017.09.003     Document Type: Review

References (117)

1. Alrawi, Y.A., Parker, R.A., Harvey, R.C., Sultanzadeh, S.J., Patel, J., Mallinson, R., et al. Predictors of early mortality among hospitalized nursing home residents. QJM 106:1 (2013), 51–57.
2. Ammitzboll, O., Maarslet, L., Early warning score in primary care in Denmark. Ugeskr. Laeger, 176(41), 2014.
3. Andrews, T., Waterman, H., Packaging: a grounded theory of how to report physiological deterioration effectively. J. Adv. Nurs. 52:5 (2005), 473–481.
4. Anon, Early warning systems: scorecards that save lives. Mo. Nurse, 2007, 19–21.
5. Anon, Expanded MEWS is more predictive: updates seen as more appropriate for ED. ED Manag. 22:4 (2010), 46–47.
6. Anon, Private homes should adopt NHS system. Nurs. Stand., 27(51), 2013, 9-.
7. Anon, Scores give us ammunition when referring patients. Nurs. Stand., 27(21), 2013, 7.
8. Anon, Sepsis screening. Nursing Manage. (Lond., Engl.: 1994), 21(7), 2014, 15.
9. Armagan, E., Yilmaz, Y., Olmez, O.F., Simsek, G., Gul, C.B., Predictive value of the modified Early Warning Score in a Turkish emergency department. Eur. J. Emerg. Med. 15:6 (2008), 338–340.
10. Asiimwe, S.B., Abdallah, A., Ssekitoleko, R., A simple prognostic index based on admission vital signs data among patients with sepsis in a resource-limited setting. Crit. Care, 19, 2015, 86.
11. Austen, C., Patterson, C., Poots, A., Green, S., Weldring, T., Bell, D., Using a local early warning scoring system as a model for the introduction of a national system. Acute Med. 11:2 (2012), 66–73.
12. Badriyah, T., Briggs, J.S., Meredith, P., Jarvis, S.W., Schmidt, P.E., Featherstone, P.I., et al. Decision-tree early warning score (DTEWS) validates the design of the national early warning score (NEWS). Resuscitation 85:3 (2014), 418–423.
13. Baker, T., Blixt, J., Lugazia, E., Schell, C.O., Mulungu, M., Milton, A., et al. Single deranged physiologic parameters are associated with mortality in a low-income country. Crit. Care Med. 43:10 (2015), 2171–2179.
14. Barlow, G., Nathwani, D., Davey, P., The CURB65 pneumonia severity score outperforms generic sepsis and early warning scores in predicting mortality in community-acquired pneumonia. Thorax 62:3 (2007), 253–259.
15. Bayer, O., Schwarzkopf, D., Stumme, C., Stacke, A., Hartog, C.S., Hohenstein, C., et al. An early warning scoring system to identify septic patients in the prehospital setting: the PRESEP score. Acad. Emerg. Med. 22:7 (2015), 868–871.
16. Beckett, D., Gordon, C., Paterson, R., Chalkley, S., Macleod, D., Bell, D., Assessment of clinical risk in the out of hours hospital prior to the introduction of hospital at night. Acute Med. 8:1 (2009), 33–38.
17. Bellomo, R., Ackerman, M., Bailey, M., Beale, R., Clancy, G., Danesh, V., et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit. Care Med. 40:8 (2012), 2349–2361.
18. Bleyer, A.J., Vidya, S., Russell, G.B., Jones, C.M., Sujata, L., Daeihagh, P., et al. Longitudinal analysis of one million vital signs in patients in an academic medical center. Resuscitation 82:11 (2011), 1387–1392.
19. Bokhari, S.W., Munir, T., Memon, S., Byrne, J.L., Russell, N.H., Beed, M., Impact of critical care reconfiguration and track-and-trigger outreach team intervention on outcomes of haematology patients requiring intensive care admission. Ann. Hematol. 89:5 (2010), 505–512.
20. Bonnici, T., Tarassenko, L., Clifton, D.A., Watkinson, P., The digital patient. Clin. Med. 13:3 (2013), 252–257.
21. Boyle, S., Critical care outreach service. N2N: Nurse2Nurse 3:10 (2003), 10–14.
22. Brabrand, M., Kellett, J., Mobility measures should be added to the national early warning score (NEWS). Resuscitation, 85(9), 2014, e151.
23. Bulut, M., Cebicci, H., Sigirli, D., Sak, A., Durmus, O., Top, A.A., et al. The comparison of modified early warning score with rapid emergency medicine score: a prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department. Emerg. Med. J. 31:6 (2014), 476–481.
24. Bunkenborg, G., Samuelson, K., Poulsen, I., Ladelund, S., Akeson, J., Lower incidence of unexpected in-hospital death after interprofessional implementation of a bedside track-and-trigger system. Resuscitation 85:3 (2014), 424–430.
25. Burch, V.C., Tarr, G., Morroni, C., Modified early warning score predicts the need for hospital admission and inhospital mortality. Emerg. Med. J. 25:10 (2008), 674–678.
26. Carmichael, H.A., Robertson, E., Austin, J., McCruden, D., Messow, C.M., Belcher, P.R., A new approach to scoring systems to improve identification of acute medical admissions that will require critical care. Scott. Med. J. 56:4 (2011), 195–202.
27. Carter, C., Physiological observations and early warning scoring tools within the deployed field hospital. J. R. Army Med. Corps 159:4 (2013), 283–286.
28. Cattermole, G.N., Liow, E.C.H., Graham, C.A., Rainer, T.H., THERM: the Resuscitation Management score. A prognostic tool to identify critically ill patients in the emergency department. Emerg. Med. J. 31:10 (2014), 803–807.
29. 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. 63:4 (2009), 591–595.
30. Challen, K., Walter, D., Physiological scoring: an aid to emergency medical services transport decisions?. Prehospital Disaster Med. 25:4 (2010), 320–323.
31. Cherry, P.G., Jones, C.P., Attitudes of nursing staff towards a modified early warning system. Br. J. Nurs. 24:16 (2015), 812–818.
32. Christensen, D., Jensen, N.M., Maaloe, R., Rudolph, S.S., Belhage, B., Perrild, H., Nurse-administered early warning score system can be used for emergency department triage. Dan. Med. Bull., 58(6), 2011, A4221.
33. Christensen, D., Jensen, N.M., Maaloe, R., Rudolph, S.S., Belhage, B., Perrild, H., Low compliance with a validated system for emergency department triage. Dan. Med. Bull., 58(6), 2011, A4294.
34. Churpek, M.M., Yuen, T.C., Huber, M.T., Park, S.Y., Hall, J.B., Edelson, D.P., Predicting cardiac arrest on the wards: a nested case-control study. Chest 141:5 (2012), 1170–1176.
35. Churpek, M.M., Yuen, T.C., Winslow, C., Hall, J., Edelson, D.P., Differences in vital signs between elderly and nonelderly patients prior to ward cardiac arrest. Crit. Care Med. 43:4 (2015), 816–822.
36. Cildir, E., Bulut, M., Akalin, H., Kocabas, E., Ocakoglu, G., Aydin, S.A., Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department. Internal Emerg. Med. 8:3 (2013), 255–260.
37. Clifton, D.A., Clifton, L., Sandu, D.M., Smith, G.B., Tarassenko, L., Vollam, S.A., et al. ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs–a database analysis. BMJ Open, 5(7), 2015, e007376.
38. Cook, C.A., Implementing the modified early obstetric warning score (MEOWS) to detect early signs of clinical deterioration and decrease maternal mortality. J. Obstet. Gynecol. Neonatal Nurs., 43(Supp. 1), 2014 S22-S.
39. Cooksley, T., Kitlowski, E., Haji-Michael, P., Effectiveness of Modified Early Warning Score in predicting outcomes in oncology patients. QJM 105:11 (2012), 1083–1088.
40. Coulter Smith, M.A., Smith, P., Crow, R., A critical review: a combined conceptual framework of severity of illness and clinical judgement for analysing diagnostic judgements in critical illness. J. Clin. Nurs. 23:5–6 (2014), 784–798.
41. Cuthbertson, B.H., Boroujerdi, M., McKie, L., Aucott, L., Prescott, G., Can physiological variables and early warning scoring systems allow early recognition of the deteriorating surgical patient?. Crit. Care Med. 35:2 (2007), 402–409.
42. Cuthbertson, B.H., Boroujerdi, M., Prescott, G., The use of combined physiological parameters in the early recognition of the deteriorating acute medical patient. J. R. Coll. Phys. Edinb. 40:1 (2010), 19–25 Erratum appears in J R Coll Physicians Edinb. 2010 Jun;40(2):190.
43. Day, T., Oxton, J., The national early warning score in practice: a reflection. Br. J. Nurs. 23:19 (2014), 1036–1040.
44. Day, B.A., Early warning system scores and response times: an audit. Nurs. Crit. Care 8:4 (2003), 156–164.
45. Drower, D., McKeany, R., Jogia, P., Jull, A., Evaluating the impact of implementing an early warning score system on incidence of in-hospital cardiac arrest. N. Z. Med. J. 126:1385 (2013), 26–34.
46. Edwards, S.E., Grobman, W.A., Lappen, J.R., Winter, C., Fox, R., Lenguerrand, E., et al. Modified obstetric early warning scoring systems (MOEWS): validating the diagnostic performance for severe sepsis in women with chorioamnionitis. Am. J. Obstet. Gynecol., 212(4), 2015 536. e1-8.
47. Essam, N., Windle, K., Mullineaux, D., Knowles, S., Gray, J., Siriwardena, N., Modified early warning scores (mews) to support ambulance clinicians' decisions to transport or treat at home. Emerg. Med. J. 32:5 (2015), e1–e.
48. Fox, A., Elliott, N., Early warning scores: a sign of deterioration in patients and systems. Nurs. Manage. (Lond., Engl.: 1994) 22:1 (2015), 26–31.
49. Fullerton, J.N., Price, C.L., Silvey, N.E., Brace, S.J., Perkins, G.D., Is the modified early warning score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment?. Resuscitation 83:5 (2012), 557–562.
50. Garcea, G., Ganga, R., Neal, C.P., Ong, S.L., Dennison, A.R., Berry, D.P., Preoperative early warning scores can predict in-hospital mortality and critical care admission following emergency surgery. J. Surg. Res. 159:2 (2010), 729–734.
51. 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. 88:6 (2006), 571–575.
52. Goldhill, D.R., McNarry, A.F., Physiological abnormalities in early warning scores are related to mortality in adult inpatients. Br. J. Anaesth. 92:6 (2004), 882–884.
53. Goldhill, D.R., McNarry, A.F., Mandersloot, G., McGinley, A., A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia 60:6 (2005), 547–553.
54. Gordo, F., Abella, A., Intensive care unit without walls: seeking patient safety by improving the efficiency of the system. Med. Intensiva 38:7 (2014), 438–443.
55. Gordon, C.F., Beckett, D.J., Significant deficiencies in the overnight use of a Standardised Early Warning Scoring system in a teaching hospital. Scott. Med. J. 56:1 (2011), 15–18.
56. Hands, C., Reid, E., Meredith, P., Smith, G.B., Prytherch, D.R., Schmidt, P.E., et al. Patterns in the recording of vital signs and early warning scores: compliance with a clinical escalation protocol. BMJ Qual. Saf. 22:9 (2013), 719–726.
57. Higgins, Y., Maries-Tillott, C., Quinton, S., Richmond, J., Promoting patient safety using an early warning scoring system. Nurs. Stand. 22:44 (2008), 35–40.
58. Huggan, P.J., Akram, F., Er, B.H., Christen, L.S., Weixian, L., Lim, V., et al. Measures of acute physiology, comorbidity and functional status to differentiate illness severity and length of stay among acute general medical admissions: a prospective cohort study. Intern. Med. J. 45:7 (2015), 732–740.
59. Jones, S., Mullally, M., Ingleby, S., Buist, M., Bailey, M., Eddleston, J.M., Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early Warning Score protocol. Crit. Care Resuscitation 13:2 (2011), 83–88.
60. Jonsson, T., Jonsdottir, H., Möller, A.D., Baldursdottir, L., Nursing documentation prior to emergency admissions to the intensive care unit. Nurs. Crit. Care 16:4 (2011), 164–169.
61. Kellett, J., Kim, A., Validation of an abbreviated VitalpacTM Early Warning Score (ViEWS) in 75,419 consecutive admissions to a Canadian regional hospital. Resuscitation 83:3 (2012), 297–302.
62. Kellett, J., Clifford, M., Ridley, A., Gleeson, M., Validation of the VitalPACTM early warning score (ViEWS) in acutely ill medical patients admitted. Ir. Med. J., 106(10), 2013, 318.
63. Kellett, J., Wang, F., Woodworth, S., Huang, W., Changes and their prognostic implications in the abbreviated VitalPACTM Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients. Resuscitation 84:4 (2013), 471–476.
64. Kolic, I., Crane, S., McCartney, S., Perkins, Z., Taylor, A., Factors affecting response to national early warning score (NEWS). Resuscitation 90 (2015), 85–90.
65. Kovacs, C., Jarvis, S.W., Prytherch, D.R., Meredith, P., Schmidt, P.E., Briggs, J.S., et al. Comparison of the National Early Warning Score in non-elective medical and surgical patients. Br. J. Surg. 103:10 (2016), 1385–1393.
66. Kyriacos, U., Jelsma, J., James, M., Jordan, S., Monitoring vital signs: development of a modified early warning scoring (MEWS) system for general wards in a developing country. PLoS ONE [Electronic Resource], 9(1), 2014, e87073.
67. Lappen, J.R., Keene, M., Lore, M., Grobman, W.A., Gossett, D.R., Existing models fail to predict sepsis in an obstetric population with intrauterine infection. Am. J. Obste. Gynecol., 203(6), 2010 573. e1-5. [Erratum appears in Am J Obstet Gynecol. 2011 Apr;204(4):359].
68. Le Jeune, I., Masterton-Smith, C., Subbe, C.P., Ward, D., State of the nation–the society for acute medicine's benchmarking audit 2013 (SAMBA ‘13). Acute Med. 12:4 (2013), 214–219.
69. Lee, J.R., Choi, H.R., Validation of a modified early warning score to predict ICU transfer for patients with severe sepsis or septic shock on general wards. J. Korean Acad. Nurs. 44:2 (2014), 219–227.
70. Li, Y.X., Ye, H.M., The prediction value of modified early warning score grade for death of the patients in intensive care unit. Chin. Crit. Care Med. 20:7 (2008), 419–421.
71. Liljehult J., Christensen T., Early warning score predicts acute mortality in stroke patients, 2015.
72. Lobo, R., Lynch, K., Casserly, L.F., Cross-sectional audit on the relevance of elevated national early warning score in medical patients at a model 2 hospital in Ireland. Ir. J. Med. Sci., 2014.
73. Ludikhuize, J., Smorenburg, S.M., de Rooij, S.E., de Jonge, E., Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the modified early warning score. J. Crit. Care 27:4 (2012), e7–13.
74. Maiocco, G., Packaging information about patient deterioration in terms of vital signs and the Early Warning Score facilitated nurses' communication with doctors. Evid. Based Nurs., 9(4), 2006, 128.
75. Martin, R.L., Midwives' experiences of using a modified early obstetric warning score (MEOWS): a grounded theory study. Evid. Based Midwifery 13:2 (2015), 59–65.
76. McBride, J., Knight, D., Piper, J., Smith, G.B., Long-term effect of introducing an early warning score on respiratory rate charting on general wards. Resuscitation 65:1 (2005), 41–44.
77. McCallum, J., Duffy, K., Hastie, E., Ness, V., Price, L., Developing nursing students' decision making skills: are early warning scoring systems helpful?. Nurse Educ. Pract. 13:1 (2013), 1–3.
78. Mohammed, M., Hayton, R., Clements, G., Smith, G., Prytherch, D., Improving accuracy and efficiency of early warning scores in acute care. Br. J. Nurs. 18:1 (2009), 18–24.
79. Moon, A., Cosgrove, J.F., Lea, D., Fairs, A., Cressey, D.M., An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary referral intensive care unit after CPR. Resuscitation 82:2 (2011), 150–154.
80. Neary, P.M., Regan, M., Joyce, M.J., McAnena, O.J., Callanan, I., National early warning score (NEWS) − evaluation in surgery. Int. J. Health Care Qual. Assur. 28:3 (2015), 245–252.
81. Neary, P.M., Regan, M., Joyce, M.J., McAnena, O.J., Callanan, I., National early warning score (NEWS) − evaluation in surgery. Int. J. Health Care Qual. Assur. 28:3 (2015), 245–252.
82. Niegsch, M., Fabritius, M.L., Anhoj, J., Imperfect implementation of an early warning scoring system in a Danish teaching hospital: a cross-sectional study. PLoS ONE [Electronic Resource], 8(7), 2013, e70068.
83. Nwulu, U., Westwood, D., Edwards, D., Kelliher, F., Coleman, J.J., Adoption of an electronic observation chart with an integrated early warning scoring system on pilot wards: a descriptive report. CIN: Comput. Inf. Nurs. 30:7 (2012), 371–379.
84. O'Driscoll, B.R., Grant, K., Green, D., Edeghere, S., Bakerly, N.D., Murphy, P., et al. Clinical and scientific letters: the national early warning score gives misleading scores for oxygen saturation in patients at risk of hypercapnia. Clin. Med. (Lond. Engl.), 15(1), 2015, 98.
85. Odell, M., Rechner, I.J., Kapila, A., Even, T., Oliver, D., Davies, C.W., et al. The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards. Resuscitation 74:3 (2007), 470–475.
86. Odell, M., Detection and management of the deteriorating ward patient: an evaluation of nursing practice. J. Clin. Nurs. 24:1–2 (2015), 173–182.
87. Omar, Y., Avoiding medical emergencies. Br. Dent. J. 214:5 (2013), 255–259.
88. Opio, M.O., Nansubuga, G., Kellett, J., Validation of the VitalPAC Early Warning Score (ViEWS) in acutely ill medical patients attending a resource-poor hospital in sub-Saharan Africa. Resuscitation 84:6 (2013), 743–746.
89. Paterson, R., MacLeod, D.C., Thetford, D., Beattie, A., Graham, C., Lam, S., et al. Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit. Clin. Med. 6:3 (2006), 281–284.
90. Perera, Y.S., Ranasinghe, P., Adikari, A.M., Welivita, W.D., Perera, W.M., Wijesundara, W.M., et al. The value of the Modified Early Warning Score and biochemical parameters as predictors of patient outcome in acute medical admissions a prospective study. Acute Med. 10:3 (2011), 126–132.
91. Peris, A., Zagli, G., Maccarrone, N., Batacchi, S., Cammelli, R., Cecchi, A., et al. The use of Modified Early Warning Score may help anesthesists in postoperative level of care selection in emergency abdominal surgery. Minerva Anestesiol. 78:9 (2012), 1034–1038.
92. Petersen, J.A., Mackel, R., Antonsen, K., Rasmussen, L.S., Serious adverse events in a hospital using early warning score—what went wrong?. Resuscitation 85:12 (2014), 1699–1703.
93. Popay J., Roberts H., Sowden A., Petticrew M., Arai L., Rodgers M., et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version. 2006;1:b92.
94. Prytherch, D.R., Smith, G.B., Schmidt, P., Featherstone, P.I., Stewart, K., Knight, D., et al. Calculating early warning scores–a classroom comparison of pen and paper and hand-held computer methods. Resuscitation 70:2 (2006), 173–178.
95. Reini, K., Fredrikson, M., Oscarsson, A., The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational study. Eur. J. Anaesthesiol. 29:3 (2012), 152–157.
96. Ridley, S., The recognition and early management of critical illness. Ann. R. Coll. Surg. Engl. 87:5 (2005), 315–322.
97. Rosedale, K., Smith, Z.A., Davies, H., Wood, D., The effectiveness of the South African Triage Score (SATS) in a rural emergency department. S. Afr. Med. J. 101:8 (2011), 537–540.
98. Rylance, J., Baker, T., Mushi, E., Mashaga, D., Use of an early warning score and ability to walk predicts mortality in medical patients admitted to hospitals in Tanzania. Trans. R. Soc. Trop. Med. Hygiene 103:8 (2009), 790–794.
99. Schmidt, P.E., Meredith, P., Prytherch, D.R., Watson, D., Watson, V., Killen, R.M., et al. Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Qual. Saf. 24:1 (2015), 10–20.
100. Shuk-Ngor, S., Chi-Wai, O., Lai-Yee, W., Chung, J.Y.M., Graham, C.A., Is the Modified Early Warning Score able to enhance clinical observation to detect deteriorating patients earlier in an Accident & Emergency Department?. Australas. Emerg. Nurs. J. 18:1 (2015), 24–32.
101. Silcock, D.J., Corfield, A.R., Gowens, P.A., Rooney, K.D., Validation of the National Early Warning Score in the prehospital setting. Resuscitation 89 (2015), 31–35.
102. Simmes, F.M., Schoonhoven, L., Mintjes, J., Fikkers, B.G., van der Hoeven, J.G., Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system. Ann. Intensive Care, 2(1), 2012, 20.
103. Smith, A.F., Oakey, R.J., Incidence and significance of errors in a patient ‘track and trigger' system during an epidemic of Legionnaires' disease: retrospective casenote analysis. Anaesthesia 61:3 (2006), 222–228.
104. Smith, T., Den Hartog, D., Moerman, T., Patka, P., Van Lieshout, E.M., Schep, N.W., Accuracy of an expanded early warning score for patients in general and trauma surgery wards. Br. J. Surg. 99:2 (2012), 192–197.
105. Smith, S., Early warning scores: effective use. Nurs. Times, 107(3), 2011, 16.
106. Stark, A.P., Maciel, R.C., Sheppard, W., Sacks, G., Hines, O.J., An early warning score predicts risk of death after in-hospital cardiopulmonary arrest in surgical patients. Am. Surg. 81:10 (2015), 916–921.
107. Stevenson, J.E., Israelsson, J., Nilsson, G.C., Petersson, G.I., Bath, P.A., Recording signs of deterioration in acute patients: the documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest. Health Inf. J., 2014.
108. Subbe, C., Falcus, J., Rutherford, P., Gemmell, L., Capacity planning: knowing the score. Health Serv. J. 113:5847 (2003), 32–33.
109. Subbe, C.P., Davies, R.G., 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 58:8 (2003), 797–802.
110. Taenzer, A.H., Pyke, J., Herrick, M.D., Dodds, T.M., McGrath, S.P., A comparison of oxygen saturation data in inpatients with low oxygen saturation using automated continuous monitoring and intermittent manual data charting. Anesthesia Analgesia 118:2 (2014), 326–331.
111. Taylor, P., Crouch, S., Howell, D.A., Dowding, D.W., Johnson, M.J., Change in physiological variables in the last 2 weeks of life: an observational study of hospital in-patients with cancer. Palliat. Med. 29:2 (2015), 120–127.
112. Teasdale, M., G. NEWS is not suitable for all patients…, McGinlay, A., Pearse, R.M., A national early warning score for acutely ill patients. BMJ, 345, 2012, e5310 8 August.). BMJ: British Medical Journal (Overseas & Retired Doctors Edition). 2012;345(7873):29-.
113. Thorpe, R., Planning a change project in mental health nursing. Nurs. Standard (R. Coll. Nurs. (Great Britain) 30:1 (2015), 38–44.
114. Watson, A., Skipper, C., Steury, R., Walsh, H., Levin, A., Inpatient nursing care and early warning scores: a workflow mismatch. J. Nurs. Care Qual. 29:3 (2014), 215–222.
115. Wheeler, I., Price, C., Sitch, A., Banda, P., Kellett, J., Nyirenda, M., et al. Early warning scores generated in developed healthcare settings are not sufficient at predicting early mortality in Blantyre, Malawi: a prospective cohort study. PLoS One, 8(3), 2013, e59830.
116. Yiu, C.J., Khan, S.U., Subbe, C.P., Tofeec, K., Madge, R.A., Into the night: factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement. Acute Med. 13:2 (2014), 56–60.
117. Young, R.S., Gobel, B.H., Schumacher, M., Lee, J., Weaver, C., Weitzman, S., Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study. Am. J. Med. Qual. 29:6 (2014), 530–537.