Hospitals allocated system resources to the end-point of continued deterioration (the training and availability of Cardiac Arrest teams), but little was in place to recognise early events that may precede this. This suspicion was confirmed in a paper by Schein et al published in Chest in 1990 which observed that of 64 patients who had arrested within 160 hours of hospital admission, 84% of them had a documented clinical deterioration preceding this.
In June 2011, after 18 months of development, Wellington Regional Hospital introduced a new adult Early Warning Score (EWS) system to replace the previous Patient At Risk (PAR) scoring system.
The new EWS system now included mandatory Medical Emergency Team (MET) calling for patients whose observations indicated they were severely ill and in need of urgent medical attention.
A graded scoring system precedes this activation with mandatory steps designed to either increase observation frequency or reverse early deterioration by increasing treatment levels and bedside expertise.
The entire system was revised in 2015 and updated based on new evidence. This was implemented in September of that year and launched with the new Paediatric EWS system.
In its first year of use in Wellington Regional Hospital, the new EWS & accompanying vital sign chart reduced in-patient cardiac arrests by 30%
ADULT EWS MATRIX
The fluid balance chart was also redesigned and united with the vital signs chart to create an A3 size colour-coded double-sided chart. This provided space for a complete set of vital signs on a single patient over a 48 hour period, along with EWS calculations and the escalation pathway (both shown above).
The EWS was subsequently revised and the vital sign charts updated during 2015 with an organisation-wide rollout of the improved system in September.
Working parties from the Paediatric and Obstetric departments were set up to look into applying similar systems in their unique areas of practice. The latter developed a Wellington 'MEOWS' chart which was implemented late in 2012. The Paediatric department adapted the revised Wellington adult chart using parameters derived from Canterbury DHB's work. The age-specific charts can be found in the online EWS library.
More information about such a proposal can be read by clicking on the nzEWS logo above.
Cardiac Arrest teams are the ambulance at the bottom of the cliff; Medical Emergency Teams are the fence at the top.
In 2016, the Wellington system was chosen as the baseline for the New Zealand Health Quality & Safety Commission's national deteriorating patient program.
Following publication of our designs, several institutions in other countries (particularly in the UK & the US) have contacted us; they are currently modifying the Wellington charts for use in their hospitals.
A proposal for an electronic system to calculate the EWS & activate the appropriate system response was placed second in the New Zealand Health IT Clinician's Challenge in 2011.
More information on Medical Emergency Team activation in Wellington Hospital can be found here.
This page was last updated on Sunday, 03 June 2018 09:07:28