Impact of introducing an electronic physiological surveillance system on hospital mortality

Abstract

BackgroundAvoidable hospital mortality is often attributable to inadequate patient vital signs monitoring, and failure to recognise or respond to clinical deterioration. The processes involved with vital sign collection and charting; their integration, interpretation and analysis; and the delivery of decision support regarding subsequent clinical care are subject to potential error and/or failure.ObjectiveTo determine whether introducing an electronic physiological surveillance system (EPSS), specifically designed to improve the collection and clinical use of vital signs data, reduced hospital mortality.MethodsA pragmatic, retrospective, observational study of seasonally adjusted in-hospital mortality rates in three main hospital specialties was undertaken before, during and after the sequential deployment and ongoing use of a hospital-wide EPSS in two large unconnected acute general hospitals in England. The EPSS, which uses wireless handheld computing devices, replaced a paper-based vital sign charting and clinical escalation system.ResultsDuring EPSS implementation, crude mortality fell from a baseline of 7.75% (2168/27 959) to 6.42% (1904/29 676) in one hospital (estimated 397 fewer deaths), and from 7.57% (1648/21 771) to 6.15% (1614/26 241) at the second (estimated 372 fewer deaths). At both hospitals, multiyear statistical process control analyses revealed abrupt and sustained mortality reductions, coincident with the deployment and increasing use of the system. The cumulative total of excess deaths reduced in all specialties with increasing use of the system across the hospital.ConclusionsThe use of technology specifically designed to improve the accuracy, reliability and availability of patients’ vital signs and early warning scores, and thereby the recognition of and response to patient deterioration, is associated with reduced mortality in this study.

A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*

“…It provides all acute services except burns, spinal injury, neurosurgical and cardiothoracic surgery to a local population of ~540,000. Routinely, staff use hand-held devices and commercially available software (VitalPAC, The Learning Clinic Ltd, London, UK) (18,19) to record all vital signs at the bedside in all adult in-patient areas of the hospital, except high care areas such as critical care units. For this study, vital signs were collected during routine clinical care from adult patients (>16 years) admitted on or after 25/05/2011 and discharged on or before 31/12/2013.…”

Finding patients before they crash: the next major opportunity to improve patient safety

“…The results of the study by Schmidt et al 12 have a number of implications. Before the approach is implemented widely, it would be helpful if the results could be validated prospectively in at least a few more hospitals.…”

“…Furthermore, the analytical approaches used do not appear to be particularly sophisticated, which suggests that even bigger improvements are probably possible. Hospital mortality has been stubbornly resistant to improvement, so the lowering of mortality at the two study hospitals reported by Schmidt et al 12 represents a truly dramatic improvement.…”

“…In the above context, the study by Schmidt et al 12 represents an important milestone. The authors used an electronic patient safety surveillance system (EPSS), while leveraging the use of electronic health records, mobile technology and analytical approaches, to find patients who appeared to be decompensating.…”

What’s new with rapid response systems?

“…Implementation of automated scoring systems may be associated with reductions in the risk of in-patient death [2]. Such systems calculate an aggregate MEWS, overcoming errors in manual summation of the individual score components.…”