Early Warning Systems (EWS) : How It Save Lives and Improve Patient Care
An Early Warning System is a framework or protocol intended to detect and respond to clinical deterioration in patients. It encompasses the tools, processes, and workflows used in healthcare settings to recognize changes in a patient’s condition and take timely action.
In fact, this system is widely implemented across healthcare facilities worldwide to ensure early recognition of vital sign alterations. As a result, accessible EWS training becomes essential to equip healthcare personnel—doctors, nurses, midwives, and all healthcare providers—with the necessary skills to prevent patient deterioration effectively.
How Early Warning Systems (EWS) Works?
Monitor Conditions: Healthcare providers use a track-and-trigger system at the bedside in general wards to monitor patients’ condition.
Score Vital Signs: The system assigns a score to any vital signs that fall outside the normal range.
Trigger Escalation: A high total score elicits an escalation protocol, which leads to clinical evaluation and prioritization based on severity.
Inadequate detection of deteriorating patients may cause more hospitalizations, unplanned ICU admissions or sudden deaths.
Areas of Early Warning System
- NEWS (National Early Warning Score): Monitors adult patients’ vital signs to identify risks of early clinical deterioration.
- PEWS (Pediatric Early Warning Score): Identifies children at risk of clinical deterioration.
- Neonatal EWS (Early Warning Score): Ensures prompt referral and treatment for newborns up to 28 days old.
- Maternity MEWS (Maternity Early Warning Score): Monitors pregnant patients up to six weeks postpartum for physiological deterioration.
Components of Early Warning Scores
The Early Warning Score vital parameters are as follows:
- Temperature. Alterations in body temperature, such as hypothermia or hyperthermia, may indicate infection, injury, or trauma.
- Respiratory rate. Changes in the rate and rhythm of breathing can signal cardiac or respiratory concerns.
- Pulse rate. Irregularities like tachycardia or bradycardia may point to underlying cardiac function problems.
- Blood Pressure. High or low blood pressure often reflects cardiovascular concerns.
- Oxygen Saturation. Below-normal oxygen saturation levels typically suggest cardiac or respiratory issues.
- Level of consciousness. Observing whether a patient is conscious, coherent, or responsive to pain or stimuli can help identify nervous system dysfunction.
Implementing EWS facilitates structured assessment, improved escalation processes, and coordinated interventions. An RN with 20 years of experience in an emergency department provided an example: “You prioritize which patients the physician should see first, and in that way, the scoring systems are clearly a helpful tool.” EWS is also considered a prioritization tool, so the patients with the highest score will be the first to be seen by the doctor.
How to Implement Early Warning System in Your Workplace?
The following steps should be taken to have an effective implementation:
- Practice Vigilance. Encourage awareness about the importance of early recognition of patient deterioration in vital signs monitoring.
- Utilize EWS tools. Use EWS score charts, checklists, and protocols for a systematized and rapid patient assessment which are aligned with the national patient safety standards (Minister of Health Regulation Number 11 of 2017).
- Assign Team Members. Delegate healthcare providers that will assume the rapid response system in your facility. This will ensure a pathway for referral and response to a clinical deterioration.
- Invest in Training. Continuous and up-to-date EWS training validates every healthcare worker is well-versed in the current best practices for patient assessment.
Cultivating a Safer Environment with Early Warning System
The Early Warning System (EWS) is an innovative protocol that helps healthcare professionals detect and respond to early signs of clinical deterioration. By implementing EWS training in your institution, healthcare professionals gain the knowledge and skills to identify vital sign deviations accurately and act before a patient’s condition worsens.
In addition, EWS promotes a more systematic approach to patient management and decision-making. As a result, it raises patient safety standards and enhances the overall quality of care in healthcare facilities.
References:
Minister of Health Regulation Number 11 of 2017 concerning Patient Safety. (2017). Republic of Indonesia.
World Health Organization. (2023). Patient safety. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/patient-safety
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