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Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration.

Publication ,  Journal Article
Bedoya, AD; Clement, ME; Phelan, M; Steorts, RC; O'Brien, C; Goldstein, BA
Published in: Crit Care Med
January 2019

OBJECTIVES: Previous studies have looked at National Early Warning Score performance in predicting in-hospital deterioration and death, but data are lacking with respect to patient outcomes following implementation of National Early Warning Score. We sought to determine the effectiveness of National Early Warning Score implementation on predicting and preventing patient deterioration in a clinical setting. DESIGN: Retrospective cohort study. SETTING: Tertiary care academic facility and a community hospital. PATIENTS: Patients 18 years old or older hospitalized from March 1, 2014, to February 28, 2015, during preimplementation of National Early Warning Score to August 1, 2015, to July 31, 2016, after National Early Warning Score was implemented. INTERVENTIONS: Implementation of National Early Warning Score within the electronic health record and associated best practice alert. MEASUREMENTS AND MAIN RESULTS: In this study of 85,322 patients (42,402 patients pre-National Early Warning Score and 42,920 patients post-National Early Warning Score implementation), the primary outcome of rate of ICU transfer or death did not change after National Early Warning Score implementation, with adjusted hazard ratio of 0.94 (0.84-1.05) and 0.90 (0.77-1.05) at our academic and community hospital, respectively. In total, 175,357 best practice advisories fired during the study period, with the best practice advisory performing better at the community hospital than the academic at predicting an event within 12 hours 7.4% versus 2.2% of the time, respectively. Retraining National Early Warning Score with newly generated hospital-specific coefficients improved model performance. CONCLUSIONS: At both our academic and community hospital, National Early Warning Score had poor performance characteristics and was generally ignored by frontline nursing staff. As a result, National Early Warning Score implementation had no appreciable impact on defined clinical outcomes. Refitting of the model using site-specific data improved performance and supports validating predictive models on local data.

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

January 2019

Volume

47

Issue

1

Start / End Page

49 / 55

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Transfer
  • Patient Acuity
  • Nursing Staff, Hospital
  • North Carolina
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans
  • Hospitals, Community
 

Citation

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ICMJE
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Bedoya, A. D., Clement, M. E., Phelan, M., Steorts, R. C., O’Brien, C., & Goldstein, B. A. (2019). Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration. Crit Care Med, 47(1), 49–55. https://doi.org/10.1097/CCM.0000000000003439
Bedoya, Armando D., Meredith E. Clement, Matthew Phelan, Rebecca C. Steorts, Cara O’Brien, and Benjamin A. Goldstein. “Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration.Crit Care Med 47, no. 1 (January 2019): 49–55. https://doi.org/10.1097/CCM.0000000000003439.
Bedoya AD, Clement ME, Phelan M, Steorts RC, O’Brien C, Goldstein BA. Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration. Crit Care Med. 2019 Jan;47(1):49–55.
Bedoya, Armando D., et al. “Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration.Crit Care Med, vol. 47, no. 1, Jan. 2019, pp. 49–55. Pubmed, doi:10.1097/CCM.0000000000003439.
Bedoya AD, Clement ME, Phelan M, Steorts RC, O’Brien C, Goldstein BA. Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration. Crit Care Med. 2019 Jan;47(1):49–55.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

January 2019

Volume

47

Issue

1

Start / End Page

49 / 55

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Transfer
  • Patient Acuity
  • Nursing Staff, Hospital
  • North Carolina
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans
  • Hospitals, Community