Abstract
Background
Trick and track systems (TTSs) are implemented to detect and prevent clinical deterioration and serious adverse events (SAE), e.g., cardiac arrest, transfer to intensive care, or unexpected death. The Early Warning Score (EWS) combines vital signs in an aggregated score without differentiating between the individual patient’s physiological response based on presenting complaints, age, and comorbidities at the point of evaluation. Therefore, there is a potential risk of missing abnormal SAE.
The study aimed to develop and implement a new system for monitoring acute patients after the initial triage and acute stabilizing phase to improve patients outcomes and optimize resources.
Methods
We developed a new TTS, the observation score (OBS) (fig. 1). It was implemented in marts 2020 in the Department of Emergency Medicine at Slagelse Hospital, Denmark. It is based on an overall assessment of the patients by the treating physician. It is a combination of the EWS score (heart rate, systolic blood pressure, arterial oxygen saturation, respiratory rate, level of consciousness, temperature, and supplemental oxygen) and the ABCDE assessment of the patient. OBS is categorized into three levels with increased alertness: Green (stable OBS), yellow (unstable OBS), and orange (critical OBS). Each group of OBS determined the subsequent observation intervals performed by the healthcare worker. OBS includes a response protocol defining escalation of care, e.g., transfer to ICU, reassessment by the physician, and increased level of OBS.
Results
A retrospective before-and-after comparative analysis of automated EWS and OBS measurements showed decreased patient assessments. The education, training, and implementation of the OBS were evaluated with an electronic questionnaire sent to the staff and showed overall satisfaction with the OBS compared to the EWS. An analysis of the short-term mortality is ongoing.
Conclusion
The new OBS for monitoring acute patients decreased unnecessary observations, thereby indicating an optimized resource allocation. The implementation of OBS was considered successful among the staff. The effect of OBS on short-term mortality is investigated in an ongoing trial.
Trick and track systems (TTSs) are implemented to detect and prevent clinical deterioration and serious adverse events (SAE), e.g., cardiac arrest, transfer to intensive care, or unexpected death. The Early Warning Score (EWS) combines vital signs in an aggregated score without differentiating between the individual patient’s physiological response based on presenting complaints, age, and comorbidities at the point of evaluation. Therefore, there is a potential risk of missing abnormal SAE.
The study aimed to develop and implement a new system for monitoring acute patients after the initial triage and acute stabilizing phase to improve patients outcomes and optimize resources.
Methods
We developed a new TTS, the observation score (OBS) (fig. 1). It was implemented in marts 2020 in the Department of Emergency Medicine at Slagelse Hospital, Denmark. It is based on an overall assessment of the patients by the treating physician. It is a combination of the EWS score (heart rate, systolic blood pressure, arterial oxygen saturation, respiratory rate, level of consciousness, temperature, and supplemental oxygen) and the ABCDE assessment of the patient. OBS is categorized into three levels with increased alertness: Green (stable OBS), yellow (unstable OBS), and orange (critical OBS). Each group of OBS determined the subsequent observation intervals performed by the healthcare worker. OBS includes a response protocol defining escalation of care, e.g., transfer to ICU, reassessment by the physician, and increased level of OBS.
Results
A retrospective before-and-after comparative analysis of automated EWS and OBS measurements showed decreased patient assessments. The education, training, and implementation of the OBS were evaluated with an electronic questionnaire sent to the staff and showed overall satisfaction with the OBS compared to the EWS. An analysis of the short-term mortality is ongoing.
Conclusion
The new OBS for monitoring acute patients decreased unnecessary observations, thereby indicating an optimized resource allocation. The implementation of OBS was considered successful among the staff. The effect of OBS on short-term mortality is investigated in an ongoing trial.
| Originalsprog | Engelsk |
|---|---|
| Status | Udgivet - 14 okt. 2021 |
| Begivenhed | Danish Emergency Medicine Conference 9 (DEMC9) - Copenhagen, Copenhagen, Danmark Varighed: 14 okt. 2021 → 15 okt. 2021 https://www.meetingplanners.dk/subsites/demc/index.html |
Konference
| Konference | Danish Emergency Medicine Conference 9 (DEMC9) |
|---|---|
| Land/Område | Danmark |
| By | Copenhagen |
| Periode | 14/10/21 → 15/10/21 |
| Internetadresse |