Applying Early Warning Score (EWS) in hospitals for adult mortality risk factors

Authors

  • Purnomo Wahyudi Gadjah Mada University
  • Viky Noviani Hemu viky
  • Suprayogi Universitas Gadjah Mada
  • Sri Setiyarini Universitas Gadjah Mada

DOI:

https://doi.org/10.31101/jhes.3294
Abstract views 23 times

Abstract

The mortality rate among adult hospital patients is a significant indicator in assessing the quality of care and health services. High mortality rates can affect a hospital's reputation, reduce the credibility of medical personnel, and trigger public anxiety. Failure to recognize the worsening of a patient's condition can delay appropriate life support management. This scoping review aims to identify and analyze the Early Warning Score (EWS) application for adults with risk factors for death in regional general hospitals (RSUD). The scoping review was conducted by searching literature using electronic databases from January 2018-May 2023, such as PubMed, ScienceDirect, LibMed UGM, and hand searching. Relevant articles were selected based on inclusion criteria. The results contained two main themes: factors related to mortality in adult patients and the benefits of implementing EWS on the clinical outcomes of adult patients. Implementing EWS in adult patients with high-risk factors for mortality at Regional General Hospitals can help identify the worsening of the patient's condition early, reducing the risk of death. Increasing awareness of the importance of EWS, EWS training, and consistent use of EWS according to hospital protocols can help reduce mortality and improve overall patient clinical outcomes.

References

Alam, N., Hobbelink, E. L., van Tienhoven, A. J., van de Ven, P. M., Jansma, E. P., & Nanayakkara, P. W. B. (2014). The impact of using the Early Warning Score (EWS) on patient outcomes: A systematic review. Resuscitation, 85(5), 587–594. https://doi.org/10.1016/j.resuscitation.2014.01.013

Al-Jabri, F., Kvist, T., Sund, R., & Turunen, H. (2021). Quality of care and patient safety at healthcare institutions in Oman: Quantitative study of the perspectives of patients and healthcare professionals. BMC Health Services Research, 21(1), 1109. https://doi.org/10.1186/s12913-021-07152-2

Andersen, L. W., Kim, W. Y., Chase, M., Berg, K. M., Mortensen, S. J., Moskowitz, A., Novack, V., Cocchi, M. N., Donnino, M. W., & American Heart Association’s Get With the Guidelines(®) – Resuscitation Investigators. (2016). The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation, 98, 112–117. https://doi.org/10.1016/j.resuscitation.2015.08.016

Arévalo-Buitrago, P., Morales-Cané, I., Olivares Luque, E., Guler, I., Rodríguez-Borrego, M. A., & López-Soto, P. J. (2021). The predictive power of early-warning scores used in hospital emergency departments: A systematic review and meta-analysis. Emergencias: Revista De La Sociedad Espanola De Medicina De Emergencias, 33(5), 374–381.

Bell, D., Baker, J., Williams, C., & Bassin, L. (2021). A Trend-Based Early Warning Score Can Be Implemented in a Hospital Electronic Medical Record to Effectively Predict Inpatient Deterioration. Critical Care Medicine, 49(10), e961–e967. https://doi.org/10.1097/CCM.0000000000005064

Credland, N., Dyson, J., & Johnson, M. J. (2018). What are the patterns of compliance with Early Warning Track and Trigger Tools: A narrative review. Applied Nursing Research: ANR, 44, 39–47. https://doi.org/10.1016/j.apnr.2018.09.002

Dagenais, G. R., Leong, D. P., Rangarajan, S., Lanas, F., Lopez-Jaramillo, P., Gupta, R., Diaz, R., Avezum, A., Oliveira, G. B. F., Wielgosz, A., Parambath, S. R., Mony, P., Alhabib, K. F., Temizhan, A., Ismail, N., Chifamba, J., Yeates, K., Khatib, R., Rahman, O., … Yusuf, S. (2020). Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): A prospective cohort study. The Lancet, 395(10226), 785–794. https://doi.org/10.1016/S0140-6736(19)32007-0

Dewi, B. A. M., Susila, I. M. D. P., & Darmawan3, A. A. K. N. (2020). Pengaruh Penggunaan Adult Early Warning Scoring (AEWS) Terhadap Tingkat Mortalitas di RSUD Bali Mandara. Jurnal Kesehatan Saelmakers PERDANA (JKSP), 3(2), Article 2. https://doi.org/10.32524/jksp.v3i2.223

Eddahchouri, Y., Koeneman, M., Plokker, M., Brouwer, E., van de Belt, T. H., van Goor, H., & Bredie, S. J. (2021). Low compliance to a vital sign safety protocol on general hospital wards: A retrospective cohort study. International Journal of Nursing Studies, 115, 103849. https://doi.org/10.1016/j.ijnurstu.2020.103849

Eddahchouri, Y., Peelen, R. V., Koeneman, M., Touw, H. R. W., van Goor, H., & Bredie, S. J. H. (2022). Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: A before-and-after study. British Journal of Anaesthesia, 128(5), 857–863. https://doi.org/10.1016/j.bja.2022.01.036

Eldawlatly, A., Alshehri, H., Alqahtani, A., Ahmad, A., Al-Dammas, F., & Marzouk, A. (2018). Appearance of Population, Intervention, Comparison, and Outcome as research question in the title of articles of three different anesthesia journals: A pilot study. Saudi Journal of Anaesthesia, 12(2), 283–286. https://doi.org/10.4103/sja.SJA_767_17

Elliott, D., Allen, E., Perry, L., Fry, M., Duffield, C., Gallagher, R., Iedema, R., McKinley, S., & Roche, M. (2015). Clinical user experiences of observation and response charts: Focus group findings of using a new format chart incorporating a track and trigger system. BMJ Quality & Safety, 24(1), 65–75. https://doi.org/10.1136/bmjqs-2013-002777

English, M., Mwaniki, P., Julius, T., Chepkirui, M., Gathara, D., Ouma, P. O., Cherutich, P., Okiro, E. A., & Snow, R. W. (2018). Hospital Mortality – a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries. BMC Medicine, 16(1), 32. https://doi.org/10.1186/s12916-018-1024-8

Flenady, T., Dwyer, T., Sobolewska, A., Lagadec, D. L., Connor, J., Kahl, J., Signal, T., & Browne, M. (2020). Developing a sociocultural framework of compliance: An exploration of factors related to the use of early warning systems among acute care clinicians. BMC Health Services Research, 20, 736. https://doi.org/10.1186/s12913-020-05615-6

Fox, A., & Elliott, N. (2015). Early Warning Scores: A sign of deterioration in patients and systems. Nursing Management (Harrow, London, England : 1994), 22, 26–31. https://doi.org/10.7748/nm.22.1.26.e1337

Fu, L.-H., Schwartz, J., Moy, A., Knaplund, C., Kang, M.-J., Schnock, K. O., Garcia, J. P., Jia, H., Dykes, P. C., Cato, K., Albers, D., & Rossetti, S. C. (2020). Development and Validation of Early Warning Score System: A Systematic Literature Review. Journal of Biomedical Informatics, 105, 103410. https://doi.org/10.1016/j.jbi.2020.103410

Gielen, A., Koekkoek, K., van der Steen, M., Looijen, M., & van Zanten, A. R. H. (2021). Evaluation of the Initial General Ward Early Warning Score and ICU Admission, Hospital Length of Stay and Mortality. The Western Journal of Emergency Medicine, 22(5), 1131–1138. https://doi.org/10.5811/westjem.2021.6.50657

Gordo, F., & Molina, R. (2018). Evolution to the early detection of severity. Where are we going? Medicina Intensiva (English Edition), 42(1), 47–49. https://doi.org/10.1016/j.medine.2017.12.002

Hidayat, D. I., Agushybana, F., & Nugraheni, S. A. (2020). Early Warning System pada Perubahan Klinis Pasien terhadap Mutu Pelayanan Rawat Inap. HIGEIA (Journal of Public Health Research and Development), 4(3), Article 3. https://doi.org/10.15294/higeia.v4i3.37842

Hogan, H., Zipfel, R., Neuburger, J., Hutchings, A., Darzi, A., & Black, N. (2015). Avoidability of hospital deaths and association with hospital-wide mortality ratios: Retrospective case record review and regression analysis. BMJ (Clinical Research Ed.), 351, h3239. https://doi.org/10.1136/bmj.h3239

Holland, M., & Kellett, J. (2023). The United Kingdom’s National Early Warning Score: Should everyone use it? A narrative review. Internal and Emergency Medicine, 18(2), 573–583. https://doi.org/10.1007/s11739-022-03189-1

Kobewka, D. M., van Walraven, C., Turnbull, J., Worthington, J., Calder, L., & Forster, A. (2017). Quality gaps identified through mortality review. BMJ Quality & Safety, 26(2), 141–149. https://doi.org/10.1136/bmjqs-2015-004735

Komisi Akreditasi Rumah Sakit. (2017). Standar Nasional Akreditasi Rumah Sakit, Edisi 1 (1st ed.). Komisi Akreditasi Rumah Sakit. http://snars.web.id/2018/fokus-pasien/pap/penilaian-pap/

Le Lagadec, M. D., & Dwyer, T. (2017). Scoping review: The use of early warning systems for the identification of in-hospital patients at risk of deterioration. Australian Critical Care, 30(4), 211–218. https://doi.org/10.1016/j.aucc.2016.10.003

Millizia, A., Rizka, A., & Mellaratna, W. P. (2023). Time Saving is Life Saving: Pelatihan Early Warning Scoring System dan Code Blue untuk Tenaga Kesehatan Ruang Rawat Inap RSUD Cut Meutia Aceh Utara | Millizia | Jurnal Malikussaleh Mengabdi. Jurnal Malikussaleh Mengabdi, 2, 242–250. https://doi.org/10. 29103/jmm.v2n1.9397

Nagarajah, S., Krzyzanowska, M. K., & Murphy, T. (2022). Early Warning Scores and Their Application in the Inpatient Oncology Settings. JCO Oncology Practice, 18(6), 465–473. https://doi.org/10.1200/OP.21.00532

O’Neill, S. M., Clyne, B., Bell, M., Casey, A., Leen, B., Smith, S. M., Ryan, M., & O’Neill, M. (2021). Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation. BMC Emergency Medicine, 21(1), 15. https://doi.org/10.1186/s12873-021-00403-9

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372. https://doi.org/10.1136/bmj.n71

Perkins, G. D., Graesner, J.-T., Semeraro, F., Olasveengen, T., Soar, J., Lott, C., Van de Voorde, P., Madar, J., Zideman, D., Mentzelopoulos, S., Bossaert, L., Greif, R., Monsieurs, K., Svavarsdóttir, H., Nolan, J. P., & European Resuscitation Council Guideline Collaborators. (2021). European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation, 161, 1–60. https://doi.org/10.1016/j.resuscitation.2021.02.003

Petersen, J. A. (2018). Early Warning Score challenges and opportunities in the care of deteriorating patients. Danish Medical Journal, 65(2), B5439.

Petersen, J. A., Mackel, R., Antonsen, K., & Rasmussen, L. S. (2014). Serious adverse events in a hospital using Early Warning Score—What went wrong? Resuscitation, 85(12), 1699–1703. https://doi.org/10.1016/j.resuscitation.2014.08.037

Petersen, J. A., Rasmussen, L. S., & Rydahl-Hansen, S. (2017). Barriers and facilitating factors related to use of Early Warning Score among acute care nurses: A qualitative study. BMC Emergency Medicine, 17, 36. https://doi.org/10.1186/s12873-017-0147-0

Rajagukguk, C. R., & Widani, N. L. (2020). Faktor-Faktor yang Berhubungan dengan Kepatuhan Pelaksanaan Monitoring Early Warning Score. Carolus Journal of Nursing, 2(2), Article 2. https://doi.org/10.37480/cjon.v2i2.37

Ramadhan, M. D. (2019). Hubungan Penerapan Early Warning Score (EWS) dengan Clinical outcomes Pasien di Instalasi Rawat Inap Dewasa RSUP Dr. Sardjito Yogyakarta [Universitas Gadjah Mada]. https://etd.repository.ugm.ac.id/penelitian/detail/178712

Salih, S. A., Abdelkader Reshia, F. A., Bashir, W. A. H., Omar, A. M., & Ahmed Elwasefy, S. (2021). Patient safety attitude and associated factors among nurses at Mansoura University Hospital: A cross sectional study. International Journal of Africa Nursing Sciences, 14, 100287. https://doi.org/10.1016/j.ijans.2021.100287

Samani, S., & Rattani, S. A. (2023). Recognizing Early Warning Signs (EWS) in Patients Is Critically Important. Open Journal of Nursing, 13(1), Article 1. https://doi.org/10.4236/ojn.2023.131004

Schmidt, P. E., Meredith, P., Prytherch, D. R., Watson, D., Watson, V., Killen, R. M., Greengross, P., Mohammed, M. A., & Smith, G. B. (2015). Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Quality & Safety, 24(1), 10–20. https://doi.org/10.1136/bmjqs-2014-003073

Semeraro, F., Greif, R., Böttiger, B. W., Burkart, R., Cimpoesu, D., Georgiou, M., Yeung, J., Lippert, F., S Lockey, A., Olasveengen, T. M., Ristagno, G., Schlieber, J., Schnaubelt, S., Scapigliati, A., & G Monsieurs, K. (2021). European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation, 161, 80–97. https://doi.org/10.1016/j.resuscitation.2021.02.008

Smith, G. B., Prytherch, D. R., Meredith, P., Schmidt, P. E., & Featherstone, P. I. (2013). The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation, 84(4), 465–470. https://doi.org/10.1016/j.resuscitation.2012.12.016

Smith, M. E. B., Chiovaro, J. C., O’Neil, M., Kansagara, D., Quiñones, A. R., Freeman, M., Motu’apuaka, M. L., & Slatore, C. G. (2014). Early warning system scores for clinical deterioration in hospitalized patients: A systematic review. Annals of the American Thoracic Society, 11(9), 1454–1465. https://doi.org/10.1513/AnnalsATS.201403-102OC

Stafseth, S. K., Grønbeck, S., Lien, T., Randen, I., & Lerdal, A. (2016). The experiences of nurses implementing the Modified Early Warning Score and a 24-hour on-call Mobile Intensive Care Nurse: An exploratory study. Intensive & Critical Care Nursing, 34, 25–33. https://doi.org/10.1016/j.iccn.2015.07.008

Susanto, E. (2019). ASUHAN KEPERAWATAN PADA NY.E DENGAN GAGAL GINJAL KRONIK DI RUANG AISYAH DALAM LT.2 RSUD SEKARWANGI KABUPATEN SUKABUMI [Diploma, Universitas Muhammadiyah Sukabumi]. http://eprints.ummi.ac.id/924/

Sutrisno, S., Pramusinto, H., & Setiyarini, S. (2022). Analisis Faktor Risiko Ketidakpatuhan Penerapan Early Warning Score Terhadap Mortalitas Pasien. Jurnal Ilmiah Keperawatan, 17(2), Article 2. https://doi.org/10.30643/jiksht.v17i2.188

Zaenal. (2022). Pengaruh Kebijakan dan Pengawasan terhadap Penerapan Pencegahan dan Pengendalian Infeksi Nosokomial di RSUD Kota Makassar | Syntax Literate ; Jurnal Ilmiah Indonesia. Jurnal Ilmiah Indonesia, 7(Spesial Issue Syntax Literate). https://doi.org/10.36418/syntax-literate.v7i2.6194

Downloads

Published

2023-09-30

Issue

Section

Literature Review

SHARE THIS