Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge

Meester, Koen De; Das, Thomas M.; Hellemans, K.; Verbrugghe, Walter; Jorens, Philippe G.; Verpooten, Gert A.; Bogaert, Peter Van

doi:10.1016/j.resuscitation.2012.06.017

Cited by 43 publications

(21 citation statements)

References 31 publications

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“…DeVoe et al [45] found that the MEWS score at admission was a predictor of death in IHCA patients. However, in agreement with Meester et al [46], our study showed poor sensitivity and specific of MEWS score, which had a significantly less AUC than the CASPRI score. Although the indexes such as RR, HR, and SBP at admission were different between the good prognosis group and the poor prognosis group, they were not caused by the independent risk factors.…”

Section: Efficacy Of Different Scoring System In Predicting 90-day Nesupporting

confidence: 92%

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

Liu¹,

Jiang²,

Sun³

et al. 2020

Preprint

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Objectives: To develop a cardiac arrest survival post-resuscitation in-hospital (CASPRI) scoring system evaluating the prognosis of neurological function in ROSC patients.Methods: This single-center, retrospective study reviewed the eligible patients admitted to the emergency department of West China Hospital of Sichuan University who received cardiopulmonary resuscitation and restored spontaneous circulation from January 1, 2014 00:00 to December 31, 2017 23:59. Clinical histories, blood test, biochemistry proﬁle, coagulation indexes and other laboratory tests during emergency department visit were collected. The MEWS, sOHCA, APACHE II, and the highest SOFA scores were calculated during the period between emergency room admission and ROSC. The clinical data of ROSC patients in the test group were analyzed by univariate and multivariate logistic analysis. The possible risk factors related to the unfavorable prognosis of 90-day neurological function were screened and CASPRI score was constructed. The eﬃcacy of CASPRI score on evaluating the neurological function of ROSC patients was analyzed by ROC curve and proved in the validation group.Main results: 503 patients were included in the test group. After correcting potential confounding factors, multivariate logistic regression analysis showed that TBIL, ALB at admission of emergency department, Lac at ROSC, resuscitation time, non-shockable rhythms were independent risk factors for poor neurological prognosis of ROSC patients (p<0.05). ROC curve showed that the CASPRI score was superior to the APACHE II score, SOFA score, MEWS score and sOHCA score, and the diﬀerence was statistically signiﬁcant (p<0.05). In the validation group with 256 patients included, the incidence of poor neurological prognosis in high-risk, intermediate-risk, and low-risk groups based on CASPRI score were 97.89%, 85.59%, and 58.33%, respectively, and the diﬀerence was statistically signiﬁcant (p<0.001). CASPRI score was superior to the SOFA score and MEWS score, the diﬀerence was statistically signiﬁcant (p<0.05).Conclusions: CASPRI score is an eﬀective tool for the early evaluation of the neurological prognosis of ROSC patients. Its eﬃcacy exceeds the MEWS and SOFA scoring systems currently used in clinical practice.

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Section: Efficacy Of Different Scoring System In Predicting 90-day Nesupporting

confidence: 92%

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

Liu¹,

Jiang²,

Sun³

et al. 2020

Preprint

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“…A study from the Netherlands 150 found that vital signs measured three times per day resulted in better detection of physiological abnormalities than a regime of taking observations only when 'clinically indicated'. Belgian researchers 151,152 reported that the use of a standard observation protocol, with observation frequency increasing according to an early warning score based on the observations, led to an increased frequency of recording vital signs, reduced hospital length of stay and mortality in postoperative patients and fewer serious adverse events for patients discharged from ICU.…”

Section: Missed Care As An Indicator Of Nurse Staffing Adequacymentioning

confidence: 99%

Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study

Griffiths

Ball

Bloor

et al. 2018

Health Serv Deliv Res

112

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Background Low nurse staffing levels are associated with adverse patient outcomes from hospital care, but the causal relationship is unclear. Limited capacity to observe patients has been hypothesised as a causal mechanism. Objectives This study determines whether or not adverse outcomes are more likely to occur after patients experience low nurse staffing levels, and whether or not missed vital signs observations mediate any relationship. Design Retrospective longitudinal observational study. Multilevel/hierarchical mixed-effects regression models were used to explore the association between registered nurse (RN) and health-care assistant (HCA) staffing levels and outcomes, controlling for ward and patient factors. Setting and participants A total of 138,133 admissions to 32 general adult wards of an acute hospital from 2012 to 2015. Main outcomes Death in hospital, adverse event (death, cardiac arrest or unplanned intensive care unit admission), length of stay and missed vital signs observations. Data sources Patient administration system, cardiac arrest database, eRoster, temporary staff bookings and the Vitalpac system (System C Healthcare Ltd, Maidstone, Kent; formerly The Learning Clinic Limited) for observations. Results Over the first 5 days of stay, each additional hour of RN care was associated with a 3% reduction in the hazard of death [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.94 to 1.0]. Days on which the HCA staffing level fell below the mean were associated with an increased hazard of death (HR 1.04, 95% CI 1.02 to 1.07), but the hazard of death increased as cumulative staffing exposures varied from the mean in either direction. Higher levels of temporary staffing were associated with increased mortality. Adverse events and length of stay were reduced with higher RN staffing. Overall, 16% of observations were missed. Higher RN staffing was associated with fewer missed observations in high-acuity patients (incidence rate ratio 0.98, 95% CI 0.97 to 0.99), whereas the overall rate of missed observations was related to overall care hours (RN + HCA) but not to skill mix. The relationship between low RN staffing and mortality was mediated by missed observations, but other relationships between staffing and mortality were not. Changing average skill mix and staffing levels to the levels planned by the Trust, involving an increase of 0.32 RN hours per patient day (HPPD) and a similar decrease in HCA HPPD, would be associated with reduced mortality, an increase in staffing costs of £28 per patient and a saving of £0.52 per patient per hospital stay, after accounting for the value of reduced stays. Limitations This was an observational study in a single site. Evidence of cause is not definitive. Variation in staffing could be influenced by variation in the assessed need for staff. Our economic analysis did not consider quality or length of life. Conclusions Higher RN staffing levels are associated with lower mortality, and this study provides evidence of a causal mechanism. There may be several causal pathways and the absolute rate of missed observations cannot be used to guide staffing decisions. Increases in nursing skill mix may be cost-effective for improving patient safety. Future work More evidence is required to validate approaches to setting staffing levels. Other aspects of missed nursing care should be explored using objective data. The implications of findings about both costs and temporary staffing need further exploration. Trial registration This study is registered as ISRCTN17930973. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 6, No. 38. See the NIHR Journals Library website for further project information.

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“…A RRT typically consist of medical and nursing staff with critical care skills that provide timely treatment to support the deteriorating patient on the ward . However, evidence for the efficacy of EWS and RRT systems at reducing in‐hospital mortality is equivocal . The management of critical illness remains a problem as some patients who are deteriorating continue to go unrecognized and appropriate, timely action is not always taken…”

Section: Introductionmentioning

confidence: 99%

Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review

Albutt

O’Hara

Conner

et al. 2016

Health Expectations

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BackgroundMeasures exist to improve early recognition of, and response to, deteriorating patients in hospital. However, deteriorating patients continue to go unrecognized. To address this, interventions have been developed that invite patients and relatives to escalate patient deterioration to a rapid response team (RRT).ObjectiveTo systematically review articles that describe these interventions and investigate their effectiveness at reducing preventable deterioration.Search strategyFollowing PRISMA guidelines, four electronic databases and two web search engines were searched to identify literature investigating patient and relative led escalation.Inclusion criteriaArticles investigating the implementation or use of systems involving patients and relatives in the detection of clinical patient deterioration and escalation of patient care to address any clinical or non‐clinical outcomes were included. Articles’ eligibility was validated by a second reviewer (20%).Data extractionData were extracted according to pre‐defined criteria.Data synthesisNarrative synthesis was applied to included studies.Main resultsNine empirical studies and 36 grey literature articles were included in the review. Limited studies were conducted to establish the clinical effectiveness of patient and relative led escalation. Instead, studies investigated the impact of this intervention on health‐care staff and available resources. Although appropriate, this reflects the infancy of research in this area. Patients and relatives did not overwhelm resources by activating the RRT. However, they did activate it to address concerns unrelated to patient deterioration.ConclusionsActivating a RRT may not be the most appropriate or cost‐effective method of resolving non‐life‐threatening concerns.

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Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge

Cited by 43 publications

References 31 publications

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study

Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review

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