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

Eveline Mestrom (Corresponding author), Ashley de Bie, Melissa van de Steeg, Merel Driessen, Louis Atallah, Rick Bezemer, R. Arthur Bouwman, Erik Korsten

Research output: Contribution to journalArticleAcademicpeer-review

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.

LanguageEnglish
Article numbere0213402
Number of pages13
JournalPLoS ONE
Volume14
Issue number5
DOIs
StatePublished - 1 May 2019

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early warning systems
Alarm systems
Length of Stay
Intensive care units
Electronic medical equipment
Mortality
Vital Signs
Electronic Health Records
research and development
retrospective studies
Tertiary Care Centers
Interoperability
Information management
Surgery
electronics
Retrospective Studies
surgery
Technology
Research

Cite this

Mestrom, Eveline ; de Bie, Ashley ; van de Steeg, Melissa ; Driessen, Merel ; Atallah, Louis ; Bezemer, Rick ; Arthur Bouwman, R. ; Korsten, Erik. / Implementation of an automated early warning scoring system in a surgical ward : practical use and effects on patient outcomes. In: PLoS ONE. 2019 ; Vol. 14, No. 5.
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title = "Implementation of an automated early warning scoring system in a surgical ward: practical use and effects on patient outcomes",
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.",
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Implementation of an automated early warning scoring system in a surgical ward : practical use and effects on patient outcomes. / Mestrom, Eveline (Corresponding author); de Bie, Ashley; van de Steeg, Melissa; Driessen, Merel; Atallah, Louis; Bezemer, Rick; Arthur Bouwman, R.; Korsten, Erik.

In: PLoS ONE, Vol. 14, No. 5, e0213402, 01.05.2019.

Research output: Contribution to journalArticleAcademicpeer-review

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N2 - 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.

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