Implementation of an Electronic National Early Warning System to Decrease Clinical Deterioration in Hospitalized Patients at a Tertiary Medical Center

• Main Authors: Chieh-Liang Wu, Chen-Tsung Kuo, Sou-Jen Shih, Jung-Chen Chen, Ying-Chih Lo, Hsiu-Hui Yu, Ming-De Huang, Wayne Huey-Herng Sheu, Shih-An Liu
• Format: Article
• Language: English
• Published: MDPI AG 2021-04-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: cardiopulmonary resuscitation; clinical deterioration; early warning score; health information system
• Online Access: https://www.mdpi.com/1660-4601/18/9/4550

The National Early Warning Score (NEWS) is an early warning system that predicts clinical deterioration. The impact of the NEWS on the outcome of healthcare remains controversial. This study was conducted to evaluate the effectiveness of implementing an electronic version of the NEWS (E-NEWS), to reduce unexpected clinical deterioration. We developed the E-NEWS as a part of the Health Information System (HIS) and Nurse Information System (NIS). All adult patients admitted to general wards were enrolled into the current study. The “adverse event” (AE) group consisted of patients who received cardiopulmonary resuscitation (CPR), were transferred to an intensive care unit (ICU) due to unexpected deterioration, or died. Patients without AE were allocated to the control group. The development of the E-NEWS was separated into a baseline (October 2018 to February 2019), implementation (March to August 2019), and intensive period (September. to December 2019). A total of 39,161 patients with 73,674 hospitalization courses were collected. The percentage of overall AEs was 6.06%. Implementation of E-NEWS was associated with a significant decrease in the percentage of AEs from 6.06% to 5.51% (<i>p</i> = 0.001). CPRs at wards were significantly reduced (0.52% to 0.34%, <i>p</i> = 0.012). The number of patients transferred to the ICU also decreased significantly (3.63% to 3.49%, <i>p</i> = 0.035). Using multivariate analysis, the intensive period was associated with reducing AEs (<i>p</i> = 0.019). In conclusion, we constructed an E-NEWS system, updating the NEWS every hour automatically. Implementing the E-NEWS was associated with a reduction in AEs, especially CPRs at wards and transfers to ICU from ordinary wards.