Comparison of general medical and general surgical nursing intervention following Early Warning Score triggers

Introduction

The Early Warning Score (EWS) [1] has been delivered within the trust for 2 years. In our institution, the EWS protocol has been modified to allow a nurse intervention when EWS = 3 (Appendix 1). The aim of the study was to look at the efficacy of nursing interventions in medical and surgical patient groups.

Method

Data were prospectively collected within the surgical and medical wards over a period of 10 weeks. We recorded information for any patient who triggered EWS ≥ 3. The person performing the first intervention and the prevention of further triggers was noted.

Results

Nurses caring for acutely unwell medical patients were able to intervene in 60% of initial triggers without having to call for a doctor (Table 1). These interventions successfully reduced the score in 60% of cases. By contrast, in the surgical group, 16% of triggers were initially dealt with by the nursing staff, and these interventions were successful in 60% of cases.

Table 1.

	Patients on medical ward	Patients on surgical ward	Fisher's exact test, P
Total triggering	500	398
Nurse therapy as first intervention	301 (60%)	42 (16%)	< 0.0001
EWS successfully reduced by nurse therapy	188 (62%)	42 (61%)	NS
Patients who retrigger following nurse therapy	110	18	NS

Appendix 1.

Early Warning Score used in Central Manchester and Manchester Children's University NHS Trust

	3	2	1	0	1	2	3
HR		≤ 40	40–50	51–100	101–110	111–129	≥ 130
SBP	≤ 70	71–80	81–100	101–199		≥ 200
RR		≤ 8		9–14	15–20	21–29	≥ 30
Temperature (°C)		≤ 35.0	35.1–36.0	36.1–37.9	≥ 38–38.9	≥ 39
CNS				Alert	Voice	Pain	Unconscious

Alert, patient is alert and orientated; Voice, patient responds to voice; Pain, patient responds to painful stimuli; Unconscious, patient is unconscious.

Conclusion

A number of factors could explain these differences: the intensive education package that accompanied the introduction of the score into medicine, differences within the patient groups, and the use of medical ward nurses assisting in the implementation of the score into their areas. Nursing intervention appears effective as first-line treatment for a trigger in many medical patients and we believe it is a useful part of the EWS protocol.