Can Early Warning Systems Enhance Detection of High Risk Patients by Rapid Response Teams?

Area of Science:

• Medical Informatics
• Critical Care Medicine
• Patient Safety

Background:

• Early recognition of patient deterioration is crucial in hospital settings.
• Rapid Response Teams (RRTs) are vital for timely intervention.
• Existing early warning systems (EWS) may have limitations in predicting critical events.

Purpose of the Study:

• To evaluate the efficacy of Visensia Safety Index (VSI) and National Early Warning Systems 2 (NEWS2) in identifying patients requiring RRT activation.
• To determine if these EWS can provide earlier alerts compared to standard RRT activation criteria.
• To assess the association between EWS alerts and patient outcomes, including hospital mortality.

Main Methods:

• Retrospective study analyzing RRT activations from 2015-2018 in a tertiary care network.
• Assessed the proportion of patients with a VSI or NEWS2 alert prior to RRT activation.
• Examined primary outcome of hospital mortality for patients with and without prior EWS alerts.

Main Results:

• Over 6,300 RRT activations were reviewed.
• VSI could have alerted 50.8% of patients a median of 3.6 hours before RRT activation; NEWS2 could have alerted 58.4% a median of 9.8 hours prior.
• Patients with prior alerts had increased odds of mortality (VSI: OR 1.2; NEWS2: OR 2.7).

Conclusions:

• Early warning systems (EWS), including VSI and NEWS2, show potential for earlier identification of deteriorating hospitalized patients.
• Utilization of EWS by RRTs may enhance recognition of patients at risk of mortality.
• Further integration of EWS into clinical practice could improve patient outcomes.