Hospitals allocated system resources to the end-point of continued deterioration (the training and availability of Cardiac Arrest teams), but little was in place to recognise early events that may precede this. This suspicion was confirmed in a paper by Schein et al published in Chest in 1990 which observed that of 64 patients who had arrested within 160 hours of hospital admission, 84% of them had a documented clinical deterioration preceding this.
In June 2011, after 18 months of development, Wellington Regional Hospital introduced a new adult Early Warning Score (EWS) system to replace the previous Patient At Risk (PAR) scoring system.
The new EWS system now included mandatory Medical Emergency Team (MET) calling for patients whose observations indicated they were severely ill and in need of urgent medical attention.
A graded scoring system precedes this activation with mandatory steps designed to either increase observation frequency or reverse early deterioration by increasing treatment levels and bedside expertise.
In its first year of use in Wellington Regional Hospital, the new EWS & accompanying vital sign chart reduced in-patient cardiac arrests by 30%
The fluid balance chart was also redesigned and united with the vital signs chart to create an A3 size colour-coded double-sided chart. This provided space for a complete set of vital signs on a single patient over a 48 hour period, along with EWS calculations and the escalation pathway (both shown above).
Working parties from the Paediatric and Obstetric departments were set up to look into applying similar systems in their unique areas of practice. The latter developed a Wellington 'MEOWS' chart which was implemented late in 2012.
More information about such a proposal can be read by clicking on the nzEWS logo above.
Cardiac Arrest teams are the ambulance at the bottom of the cliff; Medical Emergency Teams are the fence at the top.
Following publication of our designs, several institutions in other countries (particularly in the UK & the US) have contacted us; they are currently modifying the Wellington charts for use in their hospitals.
A proposal for an electronic system to calculate the EWS & activate the appropriate system response was placed second in the New Zealand Health IT Clinician's Challenge in 2011.
More information on Medical Emergency Team activation in Wellington Hospital can be found here.
This page was last updated on Saturday, 27 April 2013 20:13:15