title: Into the night: factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement.
abstract: BACKGROUND
  Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care.
  
  
  OBJECTIVE
  To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff.
  
  
  METHODS
  Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts.
  
  
  RESULTS
  During 2360 observed bed days 109 patients triggered NEWS>=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS>=6 had lower escalation rates.
  
  
  CONCLUSIONS
  Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.
authors.forename: C J
authors.initials: CJ
authors.lastname: Yiu
authors.forename: S U
authors.initials: SU
authors.lastname: Khan
authors.affiliation: Consultant in Acute Medicine, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, United Kingdom and Senior Clinical Lecturer, School of Medical Sciences, Bangor University, Bangor, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Subbe
authors.forename: K
authors.initials: K
authors.lastname: Tofeec
authors.forename: R A
authors.initials: RA
authors.lastname: Madge
mesh_terms: D039602:After-Hours Care; D000367:Age Factors; D000368:Aged; D016638:Critical Illness; D005260:Female; D016330:Frail Elderly; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D008297:Male; D009730:Nursing Assessment; D009741:Nursing Staff, Hospital; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D058996:Quality Improvement; D016414:Resuscitation Orders; D018805:Sepsis / Q000453:epidemiology; D012720:Severity of Illness Index; D014852:Wales / Q000453:epidemiology