Inpatient illness severity surveys provide essential data for planning capacity and managing patient flow in the acute hospital setting.

Abstract

We aimed to determine if Modified Early Warning Score could be used as a surrogate for the Association of United Kingdom University Hospitals dependency scoring in improving patient flow into higher areas of care. In particular, focus was to be placed on the impact of Critical Care expansion on the size of the populations of patients being managed outside of Critical Care with an Association of United Kingdom University Hospitals requirement of Level 2. We conducted snapshot assessments of illness severity using Modified Early Warning Score and Association of United Kingdom University Hospitals dependency scores on all inpatients in a large, rural acute hospital during two five-day periods. A total of 3850 patients were reviewed: 1854 in Study Period 1 and 1996 during Study Period 2. A total of 3113 (80.9%) patients had an Association of United Kingdom University Hospitals care level of 0. There was no statistically significant difference between the patients reviewed in each study period when analysed by Association of United Kingdom University Hospitals care level (p = 0.575). Eighty-nine patients required Level 2 care (inclusive of those in Critical Care). Study Period 1 had 32 Level 2 patients managed on the ward. Study Period 2 demonstrated a statistically significant increase in the proportion of these patients cared for in a Critical Care environment (37.3%-68.4% (p = 0.0036)). This was facilitated by an expansion in Critical Care capacity between the two study periods as a result of the findings in Study Period 1. We have shown that hospital inpatient data on illness severity are an essential tool in bed management and Critical Care capacity planning. We were able to demonstrate a fall in the number of Level 2 patients managed on a general ward environment following an expansion in Critical Care bed capacity. We also demonstrated that a Modified Early Warning Score of greater than 4 was associated with an increase in assessed care level requirement.