title: Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit.
abstract: This aim of this study was to assess the impact of the introduction of a standardised early warning scoring system (SEWS) on physiological observations and patient outcomes in unselected acute admissions at point of entry to care. A sequential clinical audit was performed on 848 patients admitted to a combined medical and surgical assessment unit during two separate 11-day periods. Physiological parameters (respiratory rate, oxygen saturation, temperature, blood pressure, heart rate, and conscious level), in-hospital mortality, length of stay, transfer to critical care and staff satisfaction were documented. Documentation of these physiological parameters improved (P<0.001-0.005) with the exception of oxygen saturation (P=0.069). The admission early warning score correlated both with in-hospital mortality (P<0.001) and length of stay (P=0.001). Following the introduction of the scoring system, inpatient mortality decreased (P=0.046). Staff responding to a questionnaire indicated that the scoring system increased awareness of illness severity (80%) and prompted earlier interventions (60%). A standardised early warning scoring system improves documentation of physiological parameters, correlates with in-hospital mortality, and helps predict length of stay.
authors.affiliation: Department of Acute Medicine, Western General Hospital, Edinburgh.
authors.forename: R
authors.initials: R
authors.lastname: Paterson
authors.forename: D C
authors.initials: DC
authors.lastname: MacLeod
authors.forename: D
authors.initials: D
authors.lastname: Thetford
authors.forename: A
authors.initials: A
authors.lastname: Beattie
authors.forename: C
authors.initials: C
authors.lastname: Graham
authors.forename: S
authors.initials: S
authors.lastname: Lam
authors.forename: D
authors.initials: D
authors.lastname: Bell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome