title: Our approach to changing the culture of caring for the acutely unwell patient at a large UK teaching hospital: A service improvement focus on Early Warning Scoring tools.
abstract: BACKGROUND
  Early Warning Scoring tools (EWS) play a major role in the detection of the deteriorating ward patient. EWS tools have been in place in Nottingham University Hospitals NHS Trust for over five years but compliance has been low. A service improvement project commenced across all admission wards in 2013, initiated through a financially driven CQUIN. Prior to the project, only one out of five clinical care targets set were achieved.
  
  
  METHODS
  An established framework for service improvement was used to guide delivery. The approach has consisted of multi-faceted, inter-professional high impact interventions including ward delivered education, human factors training and clinician feedback, combined with regular performance audits.
  
  
  RESULTS
  Since introduction of the service improvement team, consistent signs of improvement have been visible across the admission areas in four out of five of the clinical care targets.
  
  
  CONCLUSIONS
  The first 12 months of the project has seen tangible benefits in patient care and staff experience. Personal feedback both to medical and nursing staff has been effective where a top-down approach may not have been.
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom. Electronic address: Sally.wood@nuh.nhs.uk.
authors.forename: S D
authors.initials: SD
authors.lastname: Wood
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: J L
authors.initials: JL
authors.lastname: Candeland
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Dinning
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Dow
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Hunkin
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: McHale
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: McNeill
authors.affiliation: Nottingham University Hospital NHS Trust, Nursing Development, Derwent House, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Taylor
mesh_terms: D016638:Critical Illness / Q000451:nursing*; D004739:England; D019983:Guideline Adherence; D057209:Hospital Rapid Response Team / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D009746:Nursing, Team / Q000592:standards*; D015279:Organizational Culture; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D013222:State Medicine
keywords: Deterioration; Early warning scoring; Escalation; Quality improvement; Rapid response