Early Warning Scoring


What is
Early Warning Scoring?

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Early warning scoring (EWS) is a physiologic scoring system for bedside patient assessment. Early detection of changes in a patient’s vital signs can lead to a life-saving difference. Rapid response teams can be quickly notified of clinical instability. This leads to early intervention, thereby helping to prevent critical events before they happen.

 

When EWS is automated, hospital staff can benefit from smoother workflow, streamlined communications and a reduction in human error.

Spot subtle signs of patient deterioration quickly

 

Almost half of unanticipated hospital deaths happen on the general ward*. So how do busy care providers know which patients to watch more closely? Early Warning Scoring can help, but manual calculations take time. Philips IntelliVue Guardian Solution automates Early Warning Scoring (EWS) with the goal of improving the effectiveness of your Rapid Response Teams.

 

Put time on your side

By automatically acquiring vital signs, Philips IntelliVue Guardian can help to identify early patient deterioration, often hours before an adverse event. Customized to your own escalation protocols, the system provides a standardized view of key parameters. Deviations are noted, re-verified and immediately passed to appropriate responders.

 

More and more hospitals are seeking to implement Early Warning Scoring as an adjunct to their Rapid Response Teams. Philips IntelliVue Guardian gives you an advantage by leveraging the value of objective, actionable Early Warning Scoring to help improve patient outcomes.

Early warning scoring takes many forms

 

Acceptance of early warning scoring (EWS) has spawned a wide variety of different algorithms including MEWS, NEWS, PEWS, and more. What do they all mean?

 

EWS is based on the physiologic assessment of multiple vital signs –  respiratory rate, heart rate, systolic blood pressure, level-of-consciousness, body temperature, etc. Resulting observations are compared to a ‘normal range’ to generate a single composite score. This is done either manually, or automatically (i.e. Philips Guardian). An increasing score produces an escalated response – from increased observation, to rapid response. It is how this process is ‘modified’ to address the requirements of a specific patient/application type that results in the unique nomenclature.

 

You may also encounter Single Parameter Scoring (SPS), which scores each individual patient vital sign alone, but does not score them ‘together’ as MEWS does. With SPS, caregivers may need to consider a response when a single vital sign is out of range.

MEWS – Modified Early Warning Scoring is just that – an EWS system whose parameters have been customized to suit the requirements of a particular institution and the patients they serve. A further segmentation of MEWS adapts EWS to specific purposes. Following is a partial list:

Webinar series

 

Listen to our recent Early Warning Scoring (EWS) webinars from the industry experts and learn how EWS can help clinicians improve patient care

1 Lichliter, Royanne, and Thrasher, Jodi, PEWS: Pediatric Early Warning Signs, Rapid Response team, Code Blue, University of Colorado Denver Children’s Hospital, 2/4/09, accessed online 06/16/17, http://www.ucdenver.edu/academics/colleges/nursing/Documents/PDF/SIM_PEWS_TCH.pdf

 

2 Royal College of Physicians, National Early Warning Score (NEWS), 13 May 2015, accessed online 06/16/17, https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news

 

3 Eccles, SR, et. al., M28 From NEWS to CREWS: The chronic respiratory early warning score for patients with chronic hypoxaemia, BMJ Journals, Volume 68, Issue Suppl 3, ©2013 accessed online 06/16/17, http://thorax.bmj.com/content/68/Suppl_3/A207.1

 

4 Eccles, SR, et. al., CREWS: improving specificity whilst maintaining sensitivity of the National Early Warning Score in patients with chronic hypoxaemia, NCBI PubMed.gov, Resuscitation. 2014 Jan;85(1):109-11. doi: 10.1016/j.resuscitation.2013.08.277. Epub 2013 Sep 20, accessed online 06/16/17, https://www.ncbi.nlm.nih.gov/pubmed/24056390

 

5 Cook, Clare A., Implementing the Modified Early Obstetric Warning Score (MEOWS) to Detect Early Signs of Clinical Deterioration and Decrease Maternal Mortality, JOGNN, June 2014 Volume 43, Supplement 1, Page S22, accessed online 06/16/17, http://www.jognn.org/article/S0884-2175(15)31647-6/pdf


6 Cole, Melanie F., A modified early obstetric warning system, British Journal of Midwifery, December 2014, Vol 22, No 12, accessed online 06/16/17, http://perigen.com/wp-content/uploads/2017/05/2014-BJM-Meows.pdf