[Modified Delphi study about implementation of early warning scores]

Early warning scores (EWS) are considered an effective tool for the early detection of clinical deterioration in hospital settings. However, their implementation poses complex demands on institutional structures, processes, and culture.

As part of a modified Delphi study, experts from the Initiative Qualitätsmedizin network with practical experience in EWS implementation were invited to identify necessary structures, processes, and common pitfalls across the project phases of preparation, implementation, evaluation, and anchoring. In three rounds, recommendations were collected, thematically clustered, and rated (0-10, 10 = maximally relevant). Finally, the recommendations were consolidated in a consensus meeting.

Eight participants completed all rounds. From 505 responses, 51 consolidated recommendations were identified, all considered as highly relevant (≥ 7 points) in the various rounds. Top priorities were the training of all professional groups (mean 9.3) and transparent communication of results and actions (mean 9.0). Common barriers included lack of information technology (IT) integration, unclear responsibilities, and insufficient feedback. Key success factors were interdisciplinary project teams, early evaluation, and embedding into clinical routines.

The consensus-based recommendations can support decision-makers in the systematic implementation of EWS. Structured project planning, interprofessional training, and continuous feedback are key success factors. For sustainable integration, EWS should be embedded into quality systems, continuing education, and clinical routines.