title: Six-day postoperative impact of a standardized nurse observation and escalation protocol: a preintervention and postintervention study.
abstract: OBJECTIVE
  The purpose of the study is to determine the impact of a standardized nurse observation and escalation protocol on observation frequency, the measurement of vital signs, and the incidence of in-hospital mortality and resurgery.
  
  
  METHODS
  This is a preintervention and postintervention study by analysis of patient records for a 6-day postoperative period of all adult patients hospitalized in 4 hospital wards after surgery during a preintervention (November 2010 to March 2011; n = 2359) and postintervention (November 2011 to March 2012; n = 1888) period implementing a standardized nurse observation and escalation protocol including the Modified Early Warning Score.
  
  
  RESULTS
  The mean patient observation frequency per nursing shift increased from 0.9076 (95% confidence interval [CI], 0.8921-0.9231) preintervention to 0.9940 (95% CI, 0.9708-1.0172; P < .001) postintervention and was lower in case of 6-day postoperative mortality (0.6686 [95% CI, 0.4984-0.8388] vs other patients 0.9475 [95% CI, 0.9340-0.9610]; P = .003) or resurgery (0.8402 [95% CI, 0.7894-0.8909] vs other patients 0.9564 [95% CI, 0.9378-0.9657]; P = .003). The mean number of vital signs measured per observation episode increased from a mean of 1.81 (95% CI, 1.79-1.83) preintervention to 2.45 (95% CI, 2.39-2.51; P < .001) postintervention. The relative risk reduction was 73.7% (95% CI, 22.8-91.0; P = .015) for 6-day postoperative in-hospital mortality and 30.9% (95% CI, 9.5-47.2; P = .007) for 6-day postoperative resurgery.
authors.affiliation: Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, division of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium. Electronic address: koen.demeester@ua.ac.be.
authors.forename: Koen
authors.initials: K
authors.lastname: De Meester
authors.forename: Filip
authors.initials: F
authors.lastname: Haegdorens
authors.forename: Koenraad G
authors.initials: KG
authors.lastname: Monsieurs
authors.forename: Gert A
authors.initials: GA
authors.lastname: Verpooten
authors.forename: Annelies
authors.initials: A
authors.lastname: Holvoet
authors.forename: Peter
authors.initials: P
authors.lastname: Van Bogaert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D064648:Critical Care Nursing / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000458:organization & administration; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000592:standards*; D019370:Observation; D011184:Postoperative Period; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055986:Vital Signs
keywords: Deteriorating patients; Modified Early Warning Score/MEWS; Rapid Response System; Unexpected death; Vital signs