Beyond the intensive care unit: A review of interventions aimed at anticipating and preventing in-hospital cardiopulmonary arrest

Preoperative Early Warning Scores Can Predict In-Hospital Mortality and Critical Care Admission Following Emergency Surgery

“…Among all the admissions, there was surprisingly only one patient presenting with upper gastrointestinal hemorrhage, and it is unclear how well EWS would function in the presence of major hemorrhage, such as that found with a ruptured aortic aneurysm. Previous studies on EWS in [7][8][9][10], but there have been concerns raised regarding it applicability where patients are at risk of very sudden and catastrophic deterioration, such as cardiac arrests [11].…”

The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation

“…[1][2][3][4][5] Management of the deteriorating patient is frequently inadequate and often not assessed and managed in a timely manner. 1,3,[6][7][8] This in part can be due to the failure of nursing and medical staff to recognise early signs of patient deterioration, which in turn lead to treatment delays. 2,3,6,9 These delays are associated with unplanned admissions or readmissions into the intensive care unit (ICU), cardiac arrests and unexpected deaths.…”

“…1,3,[6][7][8] This in part can be due to the failure of nursing and medical staff to recognise early signs of patient deterioration, which in turn lead to treatment delays. 2,3,6,9 These delays are associated with unplanned admissions or readmissions into the intensive care unit (ICU), cardiac arrests and unexpected deaths. 2,3,7,8,10,11 The key element's to appropriate recognition and treatment of the deteriorating patient is accurate and timely documentation of vital signs, the ability to interpret vital sign recordings, act quickly on trends of deterioration, and availability of a medical emergency team.…”

Rapid Response Systems

“…36 In numerous studies, inadequate and delayed physician response and lack of application to the broad range of conditions that may lead to arrest precluded gathering enough evidence to support the benefit of MEWS to prevent in-hospital cardiac arrest. 37 In contrast, pairing RRS with generalized activation criteria has had better success. Note that these activation criteria emphasize the importance of medical staff discretion in addition to physiologic derangement (Table 1).…”