The National Early Warning Score (NEWS) is an early warning system that predicts clinical deterioration. The impact of the NEWS on the outcome of healthcare remains controversial. This study was conducted to evaluate the effectiveness of implementing an electronic version of the NEWS (E-NEWS), to reduce unexpected clinical deterioration. We developed the E-NEWS as a part of the Health Information System (HIS) and Nurse Information System (NIS). All adult patients admitted to general wards were enrolled into the current study. The “adverse event” (AE) group consisted of patients who received cardiopulmonary resuscitation (CPR), were transferred to an intensive care unit (ICU) due to unexpected deterioration, or died. Patients without AE were allocated to the control group. The development of the E-NEWS was separated into a baseline (October 2018 to February 2019), implementation (March to August 2019), and intensive period (September. to December 2019). A total of 39,161 patients with 73,674 hospitalization courses were collected. The percentage of overall AEs was 6.06%. Implementation of E-NEWS was associated with a significant decrease in the percentage of AEs from 6.06% to 5.51% (p = 0.001). CPRs at wards were significantly reduced (0.52% to 0.34%, p = 0.012). The number of patients transferred to the ICU also decreased significantly (3.63% to 3.49%, p = 0.035). Using multivariate analysis, the intensive period was associated with reducing AEs (p = 0.019). In conclusion, we constructed an E-NEWS system, updating the NEWS every hour automatically. Implementing the E-NEWS was associated with a reduction in AEs, especially CPRs at wards and transfers to ICU from ordinary wards.
We aimed to investigate differences in patients’ anxiety and satisfaction between patients undergoing paper-based patient decision aid (PDA) for shared decision-making (SDM) and those receiving computer-based PDA. We retrospectively collected questionnaires before and after SDM. Basic demographic data as well as anxiety, satisfaction, knowledge acquisition, and participation in SDM were recorded. We divided our population into subgroups according to use of paper-based or computer-based PDA. In addition, Pearson correlation analysis was applied to assess the relationships among variables. In total, 304 patients who visited our Division of Nephrology were included in the final analysis. Overall, over half of the patients felt anxiety (n = 217, 71.4%). Near half of the patients felt a reduction in anxiety after SDM (n = 143, 47.0%) and 281 patients (92.4%) were satisfied with the whole process of SDM. When we divided all the patients based on use of paper-based or computer-based PDA, the reduction of anxiety level was greater in the patients who underwent paper-based PDA when compared with that of those who underwent computer-based PDA. However, there was no significant difference in satisfaction between the two groups. Paper-based PDA was as effective as computer-based PDA. Further studies comparing different types of PDA are warranted to fill the knowledge gaps in the literature.
We aimed to investigate the difference in patient’s perception and satisfaction between patients undergoing paper-based Shared decision-making (SDM) and those receiving computer-based. We retrospectively collected questionnaires before and after SDM. Basic demographic data as well as anxiety, satisfaction, knowledge acquisition, and participation in SDM were recorded. We divided our population into subgroups according to paper-based or computer-based SDM. In addition, Pearson correlation analysis was applied to assess the relationships among variables. n total, 304 patients who visited our Division of Nephrology were included in the final analysis. Overall, over half of the patients felt anxiety (n = 217, 71.4%). The proportion of patients felt a reduction in anxiety after SDM (n = 143, 47.0%) and 281 patients (92.4%) were satisfied with the whole process of SDM. When we divided all of the patients based on paper-based or computer-based SDM, the reduction of anxiety level was greater in the patients who underwent paper-based SDM when compared with that of those who underwent computer-based SDM. However, there was no significant difference in satisfaction with SDM between the two groups. Paper-based SDM was as effective as computer-based SDM. Further studies from non-Western countries are warranted to gain a more complete understanding of cultural issues related to SDM.
The protocol for data retrieval, data cleaning, and data analysis for the paper: Investigating the accuracy of National Early Warning Score for predicting clinical deterioration in different disease categories and time frames
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