title: Introduction of an electronic physiological early warning system: effects on mortality and length of stay.
abstract: BACKGROUND
  The Worthing physiological scoring system (PSS) was first validated in 2005 as a tool to predict hospital mortality on admission and was subsequently introduced into clinical practice at Worthing Hospital, UK. Five years on, this study was conducted to determine the effects on mortality and length of stay (LOS) after the introduction of electronic alerting software using the PSS. In addition, we investigated whether the Worthing PSS predictive ability could be improved by addition of further variables.
  
  
  METHODS
  Prospective observational study conducted in the acute medical unit, Worthing Hospital, UK. Patient physiological data on admission and discharge/transfer were collected between February and July 2010 from the electronic alerting software VitalPAC™. Patient characteristics, co-morbidity, outcomes, and biochemistry data were taken from the hospital administration and pathology systems.
  
  
  RESULTS
  The observed mortality reduction from 8.3% to 5.2% over 5 yr was not statistically significant after adjustment for admission Worthing PSS score. Median LOS was reduced from 4 to 2 days, but this reflected an increase in short stay admissions. Worthing PSS was not significantly improved with the addition of biochemical variables or patient co-morbidity. A score taken before admission to a medical ward showed an improved predictive ability when compared with the initial admission score, but further analysis found no additional clinical benefit.
  
  
  CONCLUSIONS
  The introduction of an electronic alerting PSS did not lead to a reduction in mortality when adjusted for severity of illness defined by physiological variables. Predictive performance was not enhanced by the addition of biochemical variables and co-morbidities.
authors.affiliation: Intensive Care Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: T R
authors.initials: TR
authors.lastname: Dawes
authors.affiliation: School of Computing, Mathematical and Information Sciences, University of Brighton, Brighton BN2 4AT, UK.
authors.forename: E
authors.initials: E
authors.lastname: Cheek
authors.affiliation: School of Computing, Mathematical and Information Sciences, University of Brighton, Brighton BN2 4AT, UK.
authors.forename: V
authors.initials: V
authors.lastname: Bewick
authors.affiliation: Department of Performance and Information, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Dennis
authors.affiliation: Acute Medical Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: R W
authors.initials: RW
authors.lastname: Duckitt
authors.affiliation: Acute Medical Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Walker
authors.affiliation: Intensive Care Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: L G
authors.initials: LG
authors.lastname: Forni
authors.affiliation: Intensive Care Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK richard.venn@wsht.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Venn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods*; D010102:Oxygen Inhalation Therapy; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D012984:Software; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: hospital mortality; length of stay; medicine; monitoring, physiological; patient admission