Physiological observations and Early Warning Scoring tools within the deployed field hospital

Area of Science:

• Military Medicine
• Clinical Auditing
• Patient Safety

Background:

• The UK Role 3 Field Hospital in Afghanistan serves deployed military personnel.
• Accurate physiological monitoring and early warning scores are crucial for patient management in deployed settings.
• The Defence Medical Services (DMS) Early Warning Scoring (EWS) tool aids in identifying deteriorating patients.

Purpose of the Study:

• To assess the application of physiological observations and the DMS EWS tool in a deployed field hospital.
• To evaluate the compliance and accuracy of the DMS EWS tool before and after a change management program.

Main Methods:

• A two-phase audit of 40 ward observation charts was conducted.
• The first phase assessed baseline compliance and accuracy of the DMS EWS.
• A change management program, including feedback and teaching, was implemented between audits.

Main Results:

• Initial DMS EWS compliance was 52.5% with 33% accuracy.
• Following the intervention, compliance increased to 80% and accuracy to 59%.
• Core physiological observations were generally well-recorded, but neurological status and urine output were poorly documented.

Conclusions:

• The study highlights the importance of the DMS EWS in recognizing deteriorating patients in deployed environments.
• While compliance improved, the persistent low accuracy of the DMS EWS poses a significant patient safety risk.
• Further efforts are needed to ensure correct and consistent utilization of the DMS EWS tool in field hospitals.