This is a decidedly unsexy topic that I guarantee your Medical Director or QI committee cares about a lot. Particularly where I work, we occasionally have a prolonged boarding event, the patient isn’t reassessed in a certain time frame, the patient is transported out of the ED – and they arrive on the floor or step-down and Rapid Response is called for an unanticipated escalation in care.
This is apparently a bigger deal in the United Kingdom, because it is recommended by their government hospital body to employ a risk-stratification system to predict patient deterioration. These two articles discuss the derivation in the UK and the validation in Canada of the “ViEWS” score, which is named in part by from their electronic health record that stores their physiologic data. The general gist of the system is that the authors of the first article derived a score incorporating pulse, respiratory rate, temperature, systolic BP, O2 saturation, whether patient was on oxygen, and a measure of CNS alertness. They then compare it do several other scoring systems and amazingly enough, the scoring system they derive – using the system from the company the authors’ wives work for and in which they own shares of stock – works better than the other systems.
An abbreviated version of this is put into validation at a Canadian hospital that does not use any of the equipment, or have any financial conflict of interests. They found equally good results – which, in summation they give as four risk-stratification groups:
– < 3 points: 65% of all patients, only 0.02% died within 48 hrs.
– 3-6 points: 28% of all patients, 0.41% died within 48 hrs.
– 7-10 points: 6% of all patients, 3% died within 48 hrs.
– >11 points: 0.7% of all patients, 13.8% died within 48 hrs.
So, yes, we all can probably look at the patients scoring >11 and know they’re sick without a scoring system. However, this might be a model to look at with nursing staff to help change the parameters for floor beds or to reassess which patients can be downgraded in order to free up more intensive resources upstairs. Just don’t necessarily buy the product being hawked by the original authors.
“ViEWS—Towards a national early warning score for detecting adult inpatient deterioration.”
www.ncbi.nlm.nih.gov/pubmed/20637974
“Validation of an abbreviated VitalpacTM Early Warning Score (ViEWS) in 75,419 consecutive admissions to a Canadian Regional Hospital”
www.ncbi.nlm.nih.gov/pubmed/21907689