Abstract
Aim
To evaluate the performance of a new early warning score (EWS) system by reviewing
all serious adverse events in our hospital over a 6-month time period.
Method
All incidents of unexpected death (UD), cardiac arrest (CA) and unanticipated intensive
care unit admission(UICU) of adult patients on general wards were reviewed to see
if the escalation protocol that is part of the EWS system was followed in the 24 h preceding the event, and if not where in the chain of events failure occurred.
Results
We found 77 UICU and 67 cases of the combined outcome (CO) of CA and UD. At least
two full sets of EWS were recorded in 87, 94 and 75% of UICU, CA and UD. Patients
were monitored according to the escalation protocol in 13, 31 and 13% of UICU, CA
and UD. Nurses escalated care and contacted physicians in 64% and 60% of events of
UICU and the corresponding proportions for CO were 58% and 55%. On call physicians
provided adequate care in 49% of cases of UICU and 29% of cases of the CO. Senior
staff was involved according to protocol in 53% and 36% of cases of UICU and CO, respectively.
Conclusion
Poor compliance with the escalation protocol was commonly found when serious adverse
events occurred but level of care provided by physicians was also a problem in a hospital
with implemented early warning system. This information may prove useful in improving
performance of EWS systems.
Keywords
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Article info
Publication history
Published online: September 17, 2014
Accepted:
August 20,
2014
Received in revised form:
August 6,
2014
Received:
May 8,
2014
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.08.037.
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
