Evaluation of the Initial General Ward Early Warning Score and ICU Admission, Hospital Length of Stay and Mortality.

Anneke Gielen,Marijke Van Der Steen,Arthur Van Zanten,Kristine Koekkoek,Martijn-Looijen Looijen

doi:10.5811/westjem.2021.6.50657

Abstract

IntroductionDespite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown. We aimed to evaluate associations between the initial EWS and in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS).MethodsWe performed a retrospective cohort study of adult patients admitted to a general hospital ward between July 1, 2014–December 31, 2017. Data were obtained from electronic health records (EHR). The primary outcome was in-hospital mortality. Secondary outcomes were ICU admission and hospital LOS. We categorized patients into three risk groups (low, medium or high risk of clinical deterioration) based on EWS. Descriptive analyses were used.ResultsAfter applying inclusion and exclusion criteria, we included 53,180 patients for analysis. We found that the initial (low- vs high-risk) EWS was associated with an increased in-hospital mortality (1.5% vs 25.3%, P <0.001), an increased ICU admission rate (3.1% vs 17.6%, P <0.001), and an extended hospital LOS (4.0 days vs 8.0 days, P <0.001).ConclusionOur findings suggest that an initial high-risk EWS in patients admitted to a general hospital ward was associated with an increased risk of in-hospital mortality, ICU admission, and prolonged hospital LOS. Close monitoring and precise documentation of the EWS in the EHR may facilitate predicting poor outcomes in individual hospitalized patients and help to identify patients for whom timely and adequate management may improve outcomes.

Highlights

Despite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown
We found that the initial EWS was associated with an increased in-hospital mortality (1.5% vs 25.3%, P
Our findings suggest that an initial high-risk EWS in patients admitted to a general hospital ward was associated with an increased risk of in-hospital mortality, ICU admission, and prolonged hospital LOS

Summary

Introduction

Despite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown. Identification and management of critically ill adult patients admitted to general hospital wards may prevent inhospital mortality and unplanned intensive care unit (ICU) admission and decrease hospital length of stay (LOS).[1,2,3] Several hours before ICU admission or cardiopulmonary arrest, changes in vital signs can be detected by medical and nursing staff.[3,4,5,6] poor monitoring, misinterpretation of vital signs, and inadequate management by the clinical staff may contribute to “preventable” adverse events.[2,3,7] To systematically monitor vital signs and recognize deteriorating patients in a timely fashion, Early Warning Score (EWS) systems have been developed. The EWS is a simple-to-use bedside tool that helps to identify the critically ill patient at risk of acute clinical deterioration.[1,2,8] These track-

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