Physiological risk factors, early warning scoring systems and organizational changes

Area of Science:

• Healthcare Management
• Patient Safety
• Clinical Systems Engineering

Background:

• Medical and surgical wards face increasing numbers of critically ill patients.
• Missed indicators of acute patient deterioration lead to adverse outcomes.
• Initiatives like early warning scoring and outreach teams are being developed to mitigate these risks.

Purpose of the Study:

• To discuss the development and implementation of early warning scoring (EWS) systems or track and trigger systems.
• To explore associated organizational changes, specifically the introduction of outreach teams.
• To review the literature on systems designed to detect and respond to acute patient deterioration.

Main Methods:

• A pragmatic literature search was conducted using terms like "early warning score," "track and trigger systems," and "critical care outreach."
• Databases included CINAHL, Medline, Blackwell Synergy, and Science Direct.
• An initial 10-year limit was expanded to include relevant older literature; 35 papers were included from 645 accessed.

Main Results:

• Early warning scoring systems are not consistently utilized to their full potential.
• The precise impact of outreach teams and medical emergency teams requires further definition.
• A significant portion of literature reviewed under "decision-making tools" was irrelevant to the study's focus.

Conclusions:

• Developing and implementing EWS and outreach teams requires careful consideration of the development process rigor.
• Local requirements and needs must be reflected upon for optimal integration of these systems.
• Further research is needed to fully define the impact and best practices for these patient safety initiatives.