A Systematic Review of Early Warning Systems’ Effects on Nurses’ Clinical Performance and Adverse Events Among Deteriorating Ward Patients

Abstract

Objective Early warning systems (EWSs) are an integral part of processes that aim to improve the early identification and management of deteriorating patients in general wards. However, the widespread implementation of these systems has not generated robust data regarding nurses’ clinical performance and patients’ adverse events. This review aimed to determine the ability of EWSs to improve nurses’ clinical performance and prevent adverse events among deteriorating ward patients. Method The PubMed, CINAHL, EMBASE, and Cochrane Library databases were searched for relevant publications (January 1, 1997, to April 12, 2017). In addition, a grey literature search evaluated several guideline Web sites. The main outcome measures were nurses’ clinical performance (vital sign monitoring and rapid response team notification) and patients’ adverse events (in-hospital mortality, cardiac arrest, and unplanned intensive care unit [ICU] admission). Results The search identified 888 reports, although only five studies fulfilled the inclusion criteria. The findings of these studies revealed that EWSs implementation had a positive effect on nurses’ clinical performance, based on their frequency of documenting vital signs that were related to the patient’s clinical deterioration. In addition, postimplementation reductions were identified for cardiac arrest, unplanned ICU admission, and unexpected death. Conclusions It seems that EWSs can improve nurses’ clinical performance and prevent adverse events (e.g., in-hospital mortality, unplanned ICU admission, and cardiac arrest) among deteriorating ward patients. However, additional high-quality evidence is needed to more comprehensively evaluate the effects of EWSs on these outcomes.

An intervention including the national early warning score improves patient monitoring practice and reduces mortality: A cluster randomized controlled trial

“…These results were anticipated and in accordance with the training we supplied but somewhat contradictory when compared with previous research. In two recent systematic reviews concerning the effect of Early Warning Scores on the clinical performance of nurses, the authors concluded that the recording of vital signs improved after implementing EWSs (Lee et al, ; Saab et al., ). In most studies, an increase in the number of vital signs registered per observation was found which corresponded with our results.…”

“…Only four studies investigated the effect of an RRS on nurses’ clinical performance in vital sign registration of which three had a before and after design (Kyriacos, Jelsma, James, & Jordan, ; Meester, Haegdorens, et al, ; Mitchell et al, ; Paterson et al, ). Although these studies suggest a positive impact on the quality of the registration of vital signs, they had small sample sizes or were of limited methodological quality (Lee, Kim, Kim, & Oh, ).…”

“…In 31% of all in‐hospital preventable deaths, deterioration was not detected because of poor clinical monitoring (Hogan et al, ). As a solution to this problem, physiological track and trigger scores were developed (Lee et al, ). These scores are designed to evaluate the patient's clinical status objectively and routinely by measuring vital signs and by comparing them with predefined reference ranges.…”

“…They attributed protocol non‐compliance to increased workload, insufficient diagnostic equipment, and the limited face validity of RRS activation criteria. Furthermore, an association between compliance with the NEWS protocol and patient outcomes has never been proven (Lee et al, ). The current practice of observing patients and taking vital signs in hospitals is predominantly based on tradition and not on science (Mok, Wang, Cooper, Ang, & Liaw, ).…”

Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study

“…Prior research has shown that early warning scoring systems, such as the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS), had good predictive abilities for in-hospital mortality and cardiac arrest (Royal College of Physicians, 2012; Smith, Prytherrch, Meredith, Shmidt, & Featherstone, 2013;Smith et al, 2014). In addition, although some studies have shown that the impacts of early warning scoring systems on patient outcome were unclear or there existed low-level evidence (Alam et al, 2014; Le Lagadec & Dwyer, 2017;Smith et al, 2014), the implementation of the systems tended to have positive outcomes (Downey, Tahir, Randell, Brown, & Jayne, 2017;Lee, Kim, Kim, & Oh, 2018). However, since the efficacy of such systems depends on patient populations and care settings (Le Lagadec & Dwyer, 2017;Wheeler et al, 2013), their performance with various patients in different settings need to be explored.…”