Implementation of an Electronic National Early Warning System to Decrease Clinical Deterioration in Hospitalized...

Area of Science:

• Clinical Informatics
• Patient Safety
• Healthcare Systems Engineering

Background:

• The National Early Warning Score (NEWS) is a critical tool for predicting clinical deterioration, but its impact on patient outcomes remains debated.
• Implementing electronic health record systems offers potential to enhance the utility and consistency of early warning scores.

Purpose of the Study:

• To evaluate the effectiveness of an electronic National Early Warning Score (E-NEWS) system in reducing unexpected clinical deterioration among adult patients.
• To assess the impact of E-NEWS implementation on adverse events (AEs), including cardiopulmonary resuscitation (CPR), intensive care unit (ICU) transfers, and mortality.

Main Methods:

• Developed and integrated an E-NEWS system within existing Health Information System (HIS) and Nurse Information System (NIS).
• Collected data on 39,161 adult patients across 73,674 hospitalizations, categorizing them into AE (CPR, ICU transfer, death) and control groups.
• Analyzed AEs during baseline, implementation, and intensive E-NEWS periods (October 2018 to December 2019).

Main Results:

• Overall AEs decreased from 6.06% to 5.51% post-E-NEWS implementation (p=0.001).
• Significant reductions observed in CPR rates (0.52% to 0.34%, p=0.012) and ICU transfers (3.63% to 3.49%, p=0.035).
• Multivariate analysis indicated the intensive E-NEWS period was associated with reduced AEs (p=0.019).

Conclusions:

• The developed E-NEWS system, with automated hourly updates, effectively reduced adverse events in general hospital wards.
• E-NEWS implementation demonstrated a significant positive impact on patient safety by decreasing critical events and unplanned ICU admissions.