Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Wilrijk, Belgium.
Department of Emergency Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
J Adv Nurs. 2019 Sep;75(9):1996-2005. doi: 10.1111/jan.14034. Epub 2019 Jun 6.
To investigate the impact of the national early warning score on the frequency and the quality of vital sign registration and to study the association between protocol compliance and patient mortality.
We conducted a post hoc data analysis of a stepped wedge cluster randomized controlled trial (RCT) in six hospitals.
All adult, non-pregnant patients admitted to 24 wards were included. The intervention comprised an observation protocol using the national early warning score combined with a pragmatic medical response strategy. Data collection lasted from October 2013-May 2015. Patient comorbidity scores and vital signs were sampled every 4 months on each ward. All vital signs in the 24 hr before a serious adverse event were collected.
Patients (N = 60,956) were included of which 32,722 in the intervention group. Comorbidity scores were sampled in 3,600 patients and vital signs in 2,951 patients. In 668 patients, vital signs were collected before a serious adverse event. The mean number of vital signs per observation increased significantly in the intervention group. The observation frequency increased in patients with a serious adverse event and decreased in patients without a serious adverse event. Protocol compliance was negatively associated with patient mortality adjusted for comorbidity and age.
Our intervention improved patient monitoring practice and reduced mortality.
The impact of early warning scores on patient monitoring practice and patient outcomes remains unclear. Our intervention improved the observation of patients and reduced patient mortality. These results could support hospitals in their decision to implement rapid response systems.
We have registered this study in the clinicaltrials.gov database (identifier: NCT01949025).
调查国家早期预警评分对生命体征记录频率和质量的影响，并研究方案依从性与患者死亡率之间的关系。
我们对六家医院进行的一项阶梯式楔形集群随机对照试验（RCT）进行了事后数据分析。
所有成年、非孕妇患者入住 24 个病房均被纳入研究。干预措施包括使用国家早期预警评分和实用医疗响应策略的观察方案。数据收集时间为 2013 年 10 月至 2015 年 5 月。每个病房每 4 个月对患者合并症评分和生命体征进行采样。收集严重不良事件前 24 小时内的所有生命体征。
共纳入 60956 例患者，其中 32722 例在干预组。共对 3600 例患者进行了合并症评分采样，对 2951 例患者进行了生命体征采样。在 668 例患者中，收集了严重不良事件前的生命体征。干预组的生命体征观察次数显著增加。严重不良事件患者的观察频率增加，无严重不良事件患者的观察频率降低。在调整了合并症和年龄后，方案依从性与患者死亡率呈负相关。
我们的干预措施改善了患者监测实践并降低了死亡率。
早期预警评分对患者监测实践和患者结局的影响仍不清楚。我们的干预措施改善了患者的观察，并降低了患者死亡率。这些结果可能为医院实施快速反应系统提供支持。
我们已在 clinicaltrials.gov 数据库中注册了这项研究（标识符：NCT01949025）。
