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Early warning scores as indicators of nursing hours in general wards: A cross-sectional analysis of inpatient
Soohyun Kim1, Sung-Hyun Cho2, Eunhye Kim3
1College of Nursing, Seoul National University, Seoul, South Korea.
Background:
Physiological parameter scores and early warning score detect patient deterioration. They may also function as indicators of nursing care needs and staffing requirements, but their associations with objective staffing measures remain underexplored. Clarifying these associations may support responsive nurse staffing, alleviate nursing workload, and improve patient safety in general wards.
Objective:
To investigate the associations between seven physiological parameter scores and early warning score with nursing hours per patient day among inpatients in general wards.
Design:
Cross-sectional analysis of routine patient assessment data retrieved from the clinical database of the study setting.
Setting:
A single acute care tertiary university hospital located in Seoul, South Korea.
Participants:
32,132 early warning score recordings from 9199 inpatients in 24 medical and surgical wards in 2023.
Methods:
At each timestamp, early warning score was calculated as the sum of seven physiological parameter scores. For each patient, final parameter scores and early warning score were derived by averaging all scores within a 24-hour period. Associations between parameter scores, early warning score, and nursing hours per patient day were analyzed using separate linear regression models.
Results:
Systolic blood pressure (31.3%) and pulse rate (24.6%) showed the highest proportion of abnormal recordings, while level of consciousness (1.4%) and respiratory rate (5.2%) showed the lowest. The mean early warning score was 1.41 (SD 1.47), and the mean nursing hours per patient day was 3.16 h (SD 1.27). Multiple linear regression revealed that parameter scores varied in their association with nursing hours per patient day: respiratory rate (0.67 h, 95% CI [0.59, 0.75], p < .001), supplemental oxygen use (0.55 h, 95% CI [0.50, 0.60], p < .001), level of consciousness (0.53 h, 95% CI [0.42, 0.63], p < .001), pulse rate (0.51 h, 95% CI [0.45, 0.58], p < .001), oxygen saturation (0.06 h, 95% CI [-0.02, 0.13], p = .134), systolic blood pressure (0.05 h, 95% CI [0.01, 0.09], p = .021), and body temperature (-0.23 h, 95% CI [-0.32, -0.14], p < .001). Overall, each one-point increase in early warning score was associated with a 0.22-hour increase in nursing hours per patient day (95% CI [0.20, 0.24], p < .001).
Conclusions:
Physiological parameter scores and early warning score may serve as indicators of patient care needs and related nursing workload. They may help inform patient assignment and staffing decisions, thereby supporting workload management and safer care.
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