Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths
Background Early detection of patients with clinical deterioration admitted to the hospital is critical. The early warning system (EWS) is developed to identify early clinical deterioration. Using individual patient’s vital sign records, this bedside score can identify early clinical deterioration,...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/2/e002194.full |
| _version_ | 1797771988838645760 |
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| author | Rabia Shahid Tara Swami Ali Shams Matthew Mittelstadt Catherine Guenther Tiffanie Tse Hifsa Noor |
| author_facet | Rabia Shahid Tara Swami Ali Shams Matthew Mittelstadt Catherine Guenther Tiffanie Tse Hifsa Noor |
| author_sort | Rabia Shahid |
| collection | DOAJ |
| description | Background Early detection of patients with clinical deterioration admitted to the hospital is critical. The early warning system (EWS) is developed to identify early clinical deterioration. Using individual patient’s vital sign records, this bedside score can identify early clinical deterioration, triggering a communication algorithm between nurses and physicians, thereby facilitating early patient intervention. Although various models have been developed and implemented in emergency rooms and paediatric units, data remain sparse on the utility of the EWS in patients admitted to general internal medicine wards and the processes and challenges encountered during the implementation.Local problem There is a lack of standardised tools to recognise early deterioration of patient condition.Methods This was a quality improvement project piloted in the clinical teaching unit of a tertiary care hospital. Data were collected 24 weeks pre-EWS and 55 weeks post-EWS implementation. A series of Plan, Do, Study, Act cycles were conducted to identify the root cause, develop a driver diagram to understand the drivers of unexpected deaths, run a sham test trial run of the EWS, educate and obtained feedback of clinical care teams involved, assess adherence to the EWS during the pilot project (6 weeks pre-EWS and 6 weeks post-EWS implementation), evaluate outcomes by extending the duration to 24 weeks pre-EWS and 55 weeks post-EWS implementation, and retrospectively review the uptake of the EWS.Interventions Implementation of a standardised protocol to detect deterioration in patient condition.Results During the pre-EWS implementation phase (24 weeks), there were 4.4 events per week (1.2 septic workups, 1.9 observation unit transfers, 0.7 critical care transfers, 0.13 cardiac arrests and 0.46 per week unexpected deaths). In the post-EWS implementation phase (55 weeks), there were 4.2 events per week (1.0 septic workup, 1.9 observation unit transfers, 0.82 critical care transfers, 0.25 cardiac arrests and 0.25 unexpected deaths).Conclusion The EWS can improve patient care; however, more engagement of stakeholders and electronic vital sign documentation may improve the uptake of the system. |
| first_indexed | 2024-03-12T21:44:35Z |
| format | Article |
| id | doaj.art-adca31e838c846039f0ed9f51f065032 |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-03-12T21:44:35Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-adca31e838c846039f0ed9f51f0650322023-07-26T13:05:07ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-06-0112210.1136/bmjoq-2022-002194Implementation of early warning system in the clinical teaching unit to reduce unexpected deathsRabia Shahid0Tara Swami1Ali Shams2Matthew Mittelstadt3Catherine Guenther4Tiffanie Tse5Hifsa Noor6Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaUniversity of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaUniversity of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaUniversity of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaUniversity of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaUniversity of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaUniversity of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaBackground Early detection of patients with clinical deterioration admitted to the hospital is critical. The early warning system (EWS) is developed to identify early clinical deterioration. Using individual patient’s vital sign records, this bedside score can identify early clinical deterioration, triggering a communication algorithm between nurses and physicians, thereby facilitating early patient intervention. Although various models have been developed and implemented in emergency rooms and paediatric units, data remain sparse on the utility of the EWS in patients admitted to general internal medicine wards and the processes and challenges encountered during the implementation.Local problem There is a lack of standardised tools to recognise early deterioration of patient condition.Methods This was a quality improvement project piloted in the clinical teaching unit of a tertiary care hospital. Data were collected 24 weeks pre-EWS and 55 weeks post-EWS implementation. A series of Plan, Do, Study, Act cycles were conducted to identify the root cause, develop a driver diagram to understand the drivers of unexpected deaths, run a sham test trial run of the EWS, educate and obtained feedback of clinical care teams involved, assess adherence to the EWS during the pilot project (6 weeks pre-EWS and 6 weeks post-EWS implementation), evaluate outcomes by extending the duration to 24 weeks pre-EWS and 55 weeks post-EWS implementation, and retrospectively review the uptake of the EWS.Interventions Implementation of a standardised protocol to detect deterioration in patient condition.Results During the pre-EWS implementation phase (24 weeks), there were 4.4 events per week (1.2 septic workups, 1.9 observation unit transfers, 0.7 critical care transfers, 0.13 cardiac arrests and 0.46 per week unexpected deaths). In the post-EWS implementation phase (55 weeks), there were 4.2 events per week (1.0 septic workup, 1.9 observation unit transfers, 0.82 critical care transfers, 0.25 cardiac arrests and 0.25 unexpected deaths).Conclusion The EWS can improve patient care; however, more engagement of stakeholders and electronic vital sign documentation may improve the uptake of the system.https://bmjopenquality.bmj.com/content/12/2/e002194.full |
| spellingShingle | Rabia Shahid Tara Swami Ali Shams Matthew Mittelstadt Catherine Guenther Tiffanie Tse Hifsa Noor Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths BMJ Open Quality |
| title | Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths |
| title_full | Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths |
| title_fullStr | Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths |
| title_full_unstemmed | Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths |
| title_short | Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths |
| title_sort | implementation of early warning system in the clinical teaching unit to reduce unexpected deaths |
| url | https://bmjopenquality.bmj.com/content/12/2/e002194.full |
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