Wong, D.C.-W. orcid.org/0000-0001-8117-9193, Bonnici, T. orcid.org/0000-0003-3113-1188, Gerry, S. orcid.org/0000-0003-4654-7311 et al. (2 more authors) (2024) Effect of Digital Early Warning Scores on Hospital Vital Sign Observation Protocol Adherence: Stepped-Wedge Evaluation. Journal of Medical Internet Research, 26. e46691. ISSN 1438-8871
Abstract
Background: Early warning scores (EWS) are routinely used in hospitals to assess a patient’s risk of deterioration. EWS are traditionally recorded on paper observation charts but are increasingly recorded digitally. In either case, evidence for the clinical effectiveness of such scores is mixed, and previous studies have not considered whether EWS leads to changes in how deteriorating patients are managed.
Objective: This study aims to examine whether the introduction of a digital EWS system was associated with more frequent observation of patients with abnormal vital signs, a precursor to earlier clinical intervention.
Methods: We conducted a 2-armed stepped-wedge study from February 2015 to December 2016, over 4 hospitals in 1 UK hospital trust. In the control arm, vital signs were recorded using paper observation charts. In the intervention arm, a digital EWS system was used. The primary outcome measure was time to next observation (TTNO), defined as the time between a patient’s first elevated EWS (EWS ≥3) and subsequent observations set. Secondary outcomes were time to death in the hospital, length of stay, and time to unplanned intensive care unit admission. Differences between the 2 arms were analyzed using a mixed-effects Cox model. The usability of the system was assessed using the system usability score survey.
Results: We included 12,802 admissions, 1084 in the paper (control) arm and 11,718 in the digital EWS (intervention) arm. The system usability score was 77.6, indicating good usability. The median TTNO in the control and intervention arms were 128 (IQR 73-218) minutes and 131 (IQR 73-223) minutes, respectively. The corresponding hazard ratio for TTNO was 0.99 (95% CI 0.91-1.07; P=.73).
Conclusions: We demonstrated strong clinical engagement with the system. We found no difference in any of the predefined patient outcomes, suggesting that the introduction of a highly usable electronic system can be achieved without impacting clinical care. Our findings contrast with previous claims that digital EWS systems are associated with improvement in clinical outcomes. Future research should investigate how digital EWS systems can be integrated with new clinical pathways adjusting staff behaviors to improve patient outcomes.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © David Chi-Wai Wong, Timothy Bonnici, Stephen Gerry, Jacqueline Birks, Peter J Watkinson. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.06.2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included. |
Keywords: | vital signs; early warning score; track and trigger; electronic charting; stepped-wedge; vital; charting; documentation; deterioration; hospital management; clinical intervention; decision-making; patient risk; hospital; ICU; intensive care unit; UK; United Kingdom; intervention |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Centre for Health Services Research (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 05 Jul 2024 14:34 |
Last Modified: | 05 Jul 2024 14:34 |
Status: | Published |
Publisher: | JMIR Publications Inc. |
Identification Number: | 10.2196/46691 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:213838 |