The usage of Early Warning Systems has proved vital and extremely beneficial in the identification of health deterioration in hospitalized patients. What exactly is deterioration and why need it be detected immediately? Well, deterioration in a hospitalized patient entails or rather refers to the diminishing physiological or psychological state of a hospitalized patient to the point where it becomes harmful to the patient. It does not take place immediately but rather a slow process that may take hours before the hospital staff is aware of the problem and thus take action. The anticipation of a psychological or physiological deterioration in a patient helps in identification of patients that are at risk and thus enable these patients to get the attention they require. Vital signs that indicate the diminishing status of a patient include systolic blood pressure, heart rate, the respiratory rate, and the level of consciousness that usually comes before a cardiopulmonary arrest. Most of these signs can go unnoticed by health caregivers and hence cause detrimental effects to a patient. It is thus of utmost importance that mechanisms be used to help in prior anticipation or document possible dangers in hospitalized patients for nurses to attend adequately to such patients. Nurses have the sole responsibility of recording g vital signs in a patient that may indicate they are deteriorating. According to a study completed in the year 2004, sixty-thousand deaths of hospitalized patients occurred every year due to failures in rescue or otherwise failure of nurses to notice deteriorating changes in the patients.
The usage of early warning systems includes various instruments and the ability to combine an electronic medical record with an algorithm to prompt first and fast response and eventually help in the improvement of patient outcomes. The following research paper discusses the effectiveness of using early warning systems and follows to analyze a PICO question on the same.
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Most of the hospitalized patients in the United States that suffer from Cardiac arrests and other serious illnesses fail to make it out of the intensive care unit. The mortality of these patients is high, and even though they suffer from serious illnesses, reports suggest that some of the deaths are preventable. Such phenomenon led to the creation of the rapid response teams that seek to decrease the adverse outcomes in patients by providing critical resources for care to the deteriorating patients placed in hospital wards. However, these teams have had mixed results with some being positive and other negative. The teams are made up of humans and thus suffer the weakness of identifying deteriorating patients in sufficient and ample time to follow suit and intervene before the tragic occurrence of such things cardiac arrests.
PICO Question
In patients at risk for deterioration, is using an early warning scale more effective than not using an early warning scale in decreasing morbidity and mortality?
Literature Review
In in order to find out information, is searched the google engine for documents pertaining to the PICO Question. I searched for the terms early warning systems , detecting patient needs and Effectiveness of early warning systems . The search resulted in four articles.
Article 1
Johnson, S, Nileswar, A. (2015). Effectiveness of Modified Early Warning Score (MEWS) in the Outcome of In-Hospital Adult Cardiac Arrests in a Tertiary Hospital: Journal of Pulmonary & Respiratory Medicine, 2015.
Annotated Bibliography
The article describes the relationship between nurse strain and capacity of performance in the ICUs. It gives an in-depth analysis with relevant study results concerning the problem in hospitals. The article is important because it gives possible cases and scenarios that necessitate the need for early warning systems. The data is useful and relevant to the main topic because it gives instances where early warning systems have performed well and effectively.
Article Critique
The article is a research paper and gives conclusive data and analysis of the problems relating to nurse strain at the place of work. It shows well how strain capacities in the health care facilities affect the performance of physicians in noting patients that are in need of serious help. However, the article fails to give a specific range of data that influences the performance in hospitals. Moreover, the article does not include any downfalls of the warning systems that may require significant improvements.
Introduction
The outcomes of patients are adversely affected by an imposition of strain on the intensive care units (ICUs) due to a high demand from the aging population. The stress effect of the ICU is hardly established and more so during the time of patient admittance, and thus variations in the ICU demand grants the opportunity to study relationships between the capacity strain of ICUs and their outcomes. Research indicates that the most of these strains on the ICU are always associated with the increment inpatient mortality. The effects are significant among ICUs that use closed intensivist models of staffing as compared to those using open intensivist models. In other words, the closed models are risky and vulnerable to overwhelming from the influxes of patients despite their abilities to foster meaningful outcomes under conditions that are stable. Therefore, there is a need to have caution during the proposals to have more patients transferred to the closed ICUs.
The Intensive Care Units based in the United States are increasingly encountering a demand for critical care due to the aging population in the country. Because of this sustained increase in the baseline demand, there will be a compound demand in the effects of routine changes in critical care from epidemics of influenza to mass casualties. Therefore, the ICUs will be charged with the task of providing and delivering high-quality medical attention under the strain capacities. Several measures need to be put in place to handle the pressure near the time when the patients are discharged from these intensive care units to avoid harming the patients. However, studies conclude that mixed evidence is apparent and relates the capacity strain to the time of admission in intensive care units
Method
The study involved a qualitative approach where data was studied and content analysed in search for both relevance and usefulness. The study undertook to observe the situations where early systems were used and how effective they were.
Article 2
Gabler, N. B., Ratcliffe, S. J., Wagner, J., Asch, D. A., Rubenfeld, G. D., Angus, D. C., & Halpern, S. D. (2013). Mortality among patients admitted to strained intensive care units American journal of respiratory and critical care medicine, 188(7), 800-806.
Annotated Bibliography
The article serves to explain the mortality and modality rates of patients that get hospitalized in institutions of high strain capacities. It gives the description of how difficult it is for nurses and physicians to note problems with serious patients in the wards. It provides a case study and events of quality performance by the early warning systems. The article proves vital providing relevant data and assessment results of hospitals that have used early warning systems
Article Critique
It begins with an explanation of the systems, their relevance and instances of nurse burnout that necessitate these systems. It gives conclusive data from assessment of situations that early warning systems were employed in healthcare institutions and made well in helping patients in serious medical attention.
Introduction
A cardiac arrest always follows a period characterized by severe illness, and if these pre-arrest signals are detected soon enough, then the arrest has a high chance of being averted or prevented. However, this is an attribute that requires a reflection in the outcome improvement. A modified early warning score is a tool that has proven very useful in identifying patients who are hospitalized that are in dire need of immediate help. It also detects patients that are at a high risk of in-hospital deaths. The tool was used as a trial tool to help identify hospitalized patients that need admission and others who have an increased danger of dying in the hospital. However, the evaluation of the tool was done to a limited extent. It is imperative to understand that the return of spontaneous circulation is hardly an indication of success in resuscitation. The modified early warning score (MEWS) has five specific parameters that may be applied as rapid and a single triage method in the bid to identify patients that really need admission to hospital and those at a high risk of in-hospital death . An early score of warning is a tool that has made significant scientific evolution and proves imperative in determining changes in patient’s condition as soon as possible so that it can be handled in ample time.
Research shows that a total of one million, eighteen thousand, nine hundred and sixty-eight patients were admitted to a tertiary care hospital in the South of India. Out of the total number of patients admitted to this hospital, one thousand, nine hundred and fifty-five patients experienced cardiac arrests of sixteen point four per every one thousand admission. The gender and age distribution of these patients also contributed to the analysis and determination of significant influencing factors (Mathukia, 2015). However, it was also determined that the numbers were better in the Post MEWS periods. According to the statistics, many patients that were in the post MEWS time underwent a ROSC cardiac arrest.
Method
The following research applied a qualitative design of data collection and analysis. Content analysis was done on several kinds of literature concerning the effectiveness of using early warning systems. Literature was studied and analyzed depending on the chosen population, year of study and variables used. Moreover, the study entailed analyzing trends in the development of the warning systems and how effective they have been in various health care institutions. The content analysis took note of literature that discussed previous and post-mortality rates in hospitals before and after the introduction of these warning systems respectively. The study focused on the numbers because they give a denser argument to a research problem and conclusive results and indication to the problem in question. Secondly, the study design was fixated on institutions in America although a few consultative documents from European countries have been investigated. The principal reason for studying the literature on American health care facilities is that the issue or problem under research has significance in the country primarily because of the aging population. Therefore, the study method entailed consideration of based state as a principal factor in the analysis of the literature.
The literature material study shows a significant consistency in information regarding the warning systems. It is apparent that the effectiveness of the warning systems exceeds the expectation. According to the material of study, the least percentage experienced in the improvement of cardiac arrests in hospitals using the notification tools is five percent. Cardiac arrest has been the primary area of focus because it is a major problem in the American hospitals and has the highest number of mortality considering the selected population. The materials also conclude that nurses are better in their work with the assistance of these tools as compared to without.
Discussion
A hospital as earlier indicated has numerous activities. Sometimes, these actions overwhelm the physicians and nurses present in a particular health facility to the extent of them being relaxed not to notice that a patient is in critical need of assistance and intensive care. detection of events of deterioration in the health of a patient marks the first step towards remedying the problem (Wang, 2016). According to the study findings, these tools that help doctors deduce if a patient is in need of immediate and extraordinary care have contributed to saving many lives. Moreover, the methods or systems rather have been on the forefront of ensuring that the patients recover and can proceed with their lives even after discharge. MEWS that include points show no significant variation in triage between groups of people that are initial admissions and those that are on discharge. However, every point detects a problem with a patient and increases the possibilities of reducing the adversities of the illness considering it was to take a toll on the concerned party (Mathukia, 2015). It is easy to notice the signals with the tools than it is to the nurse or physician in charge. Such tools go about to suggest that predictors such as sex as well as other risk factors come best during the last stages of the illness. The last stage is always intense and challenging for any one person to note and thus make progress in identifying and solving the problem.
The deterioration that is in the nearest vital sign is hard to determine for the nurse as well as recording accurately in an emergency department setting. The study indicates that the physiology of the patient and probable reserves are considered vital predictors of IHCA outcomes (Mathukia, 2015). This information further confirms the fact that it is tough to deduce the late stage signals that are detrimental to the health of a mainly hospitalized patient. If at all, the situation is not recognized or is inadequately treated the patients undergoing clinical deterioration experience progression of organ failure and a cardiac arrest follows. The outcomes are thus generally poor in an institution that depends on the physical observation to detect problems with hospitalized patients. However, statistically, the warning systems prove to improve the chances of survival because they allow a patient the opportunity to get care that they are in much need of. According to (Johnson, 2015), outcomes that involved the IHCA are usually poorer than the results found in cases where the warning systems have been applied. The survival rates to the point of discharge have immensely increased in the past decade courtesy of the introduction of the warning systems. The improvement has happened regardless of a shockable or no shockable activity of pulses. According to (Mathukia, 2015), the rates of discharging patients between the years 2000 and 2009 were seventeen percent in the United States. However, the number now stands at twenty-two point two percent following the new systems of detecting signals that a patient requires better attention from the caregivers. The risk of cardiac arrest triage score employs the vital signs of a ward that include the respiratory and heart rates, the diastolic pressure of blood and age. All these are used from the time of admission to that when a cardiac arrest occurs. The score intends to make a better control trigger for the response team in the identification of patients at high risks of suffering potential adverse events (Johnson, 2015). Therefore, the question on the efficacy and efficiency of these warning systems is hardly one to struggle over answering. It is clear that these warning systems prove sufficiently useful.
Conclusion
Warning systems help detect signs that a patient is in need of immediate and special care from the doctor or nurse. Hospitalized patients suffer from many things, and some of these problems can lead to their deaths if not taken care of immediately. It is difficult for the nurses to observe the signs that are vital before a person dies but the predictor systems can. Research confirms that most of the deaths that take place in intensive care units are preventable if at all the signs of an imminent death are noted and treated immediately. It is also possible to have patients survive and leave normal lives after discharge as long as these systems have been put in place and are well used. Therefore, it is safe to say that indeed these warning systems are effective.
References
Gabler, N. B., Ratcliffe, S. J., Wagner, J., Asch, D. A., Rubenfeld, G. D., Angus, D. C., & Halpern, S. D. (2013). Mortality among patients admitted to strained intensive care units American journal of respiratory and critical care medicine, 188(7), 800-806. Doi: http://www.atsjournals.org/doi/abs/10.1164/rccm.201304-0622OC
Johnson, S, Nileswar, A. (2015). Effectiveness of Modified Early Warning Score (MEWS) in the Outcome of In-Hospital Adult Cardiac Arrests in a Tertiary Hospital: Journal of Pulmonary & Respiratory Medicine, 2015. Doi: 10.4172/2161-105X.1000285
Mathukia, C., Fan, W., Vadyak, K., Biege, C., & Krishnamurthy, M. (2015). Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital: Journal of community hospital internal medicine perspectives, 5(2). Doi: http://dx.doi.org/10.3402/jchimp.v5.26716
Wang, A. Y., Fang, C. C., Chen, S. C., Tsai, S. H., & Kao, W. F. (2016). Periarrest Modified Early Warning Score (MEWS) predicts the outcome of in-hospital cardiac arrest. Journal of the Formosan Medical Association, 115(2), 76-82. Doi: http://dx.doi.org/10.1016/j.jfma.2015.10.016
Rogers, D., Tsirkunov, V. (2011). Costs and benefits of early warning systems: Global Assessment Report on Disaster Risk Reduction. Doi: http://www.preventionweb.net/english/hyogo/gar/2011/en/bgdocs/Rogers_%26_Tsirkunov_2011.pdf
