Definition

An early warning score (EWS) is a clinical decision support tool used to quickly assess the severity of illness in a patient. It is based on clinical physiologic data including blood pressure, heart rate, respiratory rate and temperature. It also may include observational data such as level of consciousness. The EWS is calculated based on the parameters measured; higher scores correlate with increasing severity of illness.

Effectiveness

In order to be effective, early warning scores, like single-parameter alarms, must monitor the status of the patient and have a defined activation criteria that prompts intervention. However, unlike single-parameter alarms, which have been demonstrated to have specificities as low as 15%([FOOTNOTE=Siebig, S., Kuhls, S., Imhoff, M., Gather, U., Scholmerich, J., & Wrede, C. E. Intensive care unit alarms--how many do we need? Crit Care Med. 2010;38(2):451-456.],[ANCHOR=],[LINK=]), early warning scores have demonstrated improved sensitivity and specificity to adverse events.([FOOTNOTE=Prytherch, D. R., Smith, G. B., Schmidt, P. E., & Featherstone, P. I. ViEWS--Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation. 2010;81(8):932-937.],[ANCHOR=],[LINK=]) Several clinical studies have demonstrated the ability of EWS implementation to improve patient outcomes.([FOOTNOTE=Bellomo, R., Ackerman, M., Bailey, M., et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349-2361.],[ANCHOR=],[LINK=]),([FOOTNOTE=DeVita, M. A., Braithwaite, R. S., Mahidhara, R., Stuart, S., Foraida, M., & Simmons, R. L. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13(4):251-254.],[ANCHOR=],[LINK=]),([FOOTNOTE=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. 2011;82(2):150-154.],[ANCHOR=],[LINK=])

Clinical Outcomes

Bellomo et al. reported on a study, involving close to 20,000 patients and 10 hospitals on three different continents, and found that the use of an automated clinical decision support system, when compared with hospitals’ previous practices for measuring vital signs and calculating EWS to activate a rapid response team (RRT), is associated with increased survival immediately after RRT treatment; shorter median hospital length of stay in patients in the U.S. hospitals included in the study; and shorter time to complete and record a set of vital signs.([FOOTNOTE=Bellomo, R., Ackerman, M., Bailey, M., et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349-2361.],[ANCHOR=],[LINK=])

Economic Impact

An evaluation of the cost savings attributable to implementing a continuous monitoring system in a 316-bed medical-surgical unit revealed the average net benefit ranged from $224 to $710 per patient per year. The cost savings were attributed to decreases in length of hospital stay and ICU length of stay for patients transferred from general care floors.([FOOTNOTE=Slight, S. P., Franz, C., Olugbile, M., Brown, H. V., Bates, D. W., & Zimlichman, E. The return on investment of implementing a continuous monitoring system in general medical-surgical units. Crit Care Med. 2014;42(8):1862-1868.],[ANCHOR=],[LINK=])

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VITAL SYNC™ EARLY WARNING SCORE APP

The Vital Sync™ early warning score (EWS) app helps hospitals realize the benefits of using an automated early warning system. The app continuously monitors patient information from multiple bedside and wearable devices, EMRs as well as data that has been manually entered by clinicians, to automatically calculate an EWS based on your facility’s chosen algorithm. Clinicians know when the first signs of patient deterioration appear so they can take the appropriate action.

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