title: The introduction of an integrated early warning score observation chart-a picture paints a thousand words.
abstract: OBJECTIVE
  Previous studies have demonstrated that abnormal physiological observations are often recorded on patients' observation charts but not acted on, with ensuing negative consequences. To address this issue within our hospital, traditional charts with a graphic depiction of observations were replaced with new charts combining early warning scores (EWS) with numerically depicted observations. However, the replacement did not include a graphic display of observations in the form of trend graphs. The present study compared the speed and accuracy of data interpretation between the 2 charts.
  
  
  METHODS
  Six clinical scenarios (low-grade temperature, spiking temperature, tachypnea, Cushing's response, hypovolaemic shock and normal observations) were identically depicted on old and new charts, creating 12 charts. One hundred health-care professionals were asked to study each of the charts, and the time taken to give a diagnosis was recorded. Time taken and accuracy of response were compared between the 2 charts.
  
  
  RESULTS
  The old chart was associated with faster responses in all of the scenarios, reaching statistical significance in 5 of the 6 scenarios (P < 0.0001). Additionally, the response was more accurate in all of the scenarios, reaching statistical significance in 3 of the 6 scenarios (P < 0.0001). Overall, response to the old chart was 1.6 times faster (P < 0.0001) and 15% more accurate (90% versus 75%, P < 0.0001) than the new chart.
  
  
  CONCLUSIONS
  Graphic display of data is associated with faster and more accurate assimilation of information. Hence, charts combining EWS with graphic portrayal of observation trends may contribute to earlier recognition of sick patients.
authors.affiliation: From the Department of Surgery, Basildon and Thurrock University Hospitals NHS Foundation Trust, Nethermayne, Basildon, Essex, United Kingdom.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fung
authors.forename: Farrukh
authors.initials: F
authors.lastname: Khan
authors.forename: Joseph
authors.initials: J
authors.lastname: Dawson
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000458:organization & administration*; D042241:Early Diagnosis; D006282:Health Personnel; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015588:Observer Variation; D010818:Practice Patterns, Physicians'; D063189:Symptom Assessment / Q000379:methods*; D055986:Vital Signs