Implementing an electronic observation and early warning score chart in the emergency department: a feasibility study

Background - Use of automated systems to aid identification of patient deterioration in routine hospital practice is limited and their impact on patient outcomes remains unclear. This study was designed to evaluate the feasibility of implementing an electronic observation chart with automated early warning score calculation in the high acuity area of an emergency department. Methods - This study enrolled approximately 3,000 subjects before and 3,000 after implementation of an automated system, using bedside vital signs entry on networked mobile devices. The primary outcome measure was the percentage of subjects for whom an early warning score was accurately recorded in each stage. Results - 52.7% of subjects before and 92.9% after implementation of the electronic system had an accurate EWS recorded on charts available to the study team. Subject groups were well balanced for baseline characteristics and acuity. Conclusions - In this study the feasibility and limitations of implementing an electronic observation chart in ED were demonstrated. Accurate EWS documentation was more frequent after implementation of the electronic observation chart. Retrospective analysis suggests that the use of an electronic observation system may lead to a greater percentage of observations being taken from those patients with a higher EWS.