title: Implementing an electronic observation and early warning score chart in the emergency department: a feasibility study.
abstract: BACKGROUND
  Use of automated systems to aid identification of patient deterioration in routine hospital practice is limited and their impact on patient outcomes remains unclear. This study was designed to evaluate the feasibility of implementing an electronic observation chart with automated early warning score (EWS) calculation in the high-acuity area of an emergency department.
  
  
  METHODS
  This study enrolled 3219 participants before and 3352 after implementation of an automated system, using bedside vital-sign entry on networked mobile devices. The primary outcome measure was the percentage of participants for whom an EWS was accurately recorded at each stage.
  
  
  RESULTS
  Of the participants, 52.7% before and 92.9% after implementation of the electronic system had an accurate EWS recorded on charts available to the study team. Participant groups were well balanced for baseline characteristics and acuity.
  
  
  CONCLUSIONS
  In this study, the feasibility and limitations of implementing an electronic observation chart in the ED were demonstrated. Accurate EWS documentation was more frequent after implementation of the electronic observation chart. Retrospective analysis suggests that the use of an electronic observation system may lead to a greater percentage of observations being taken from those patients with a higher EWS.
authors.affiliation: aEmergency Department, John Radcliffe Hospital bDepartment of Engineering Science, Institute of Biomedical Engineering cCentre for Statistics in Medicine, Botnar Research Centre, Oxford University, Oxford dEmergency Department, Wexham Park Hospital, Slough, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Pullinger
authors.forename: Sarah
authors.initials: S
authors.lastname: Wilson
authors.forename: Rob
authors.initials: R
authors.lastname: Way
authors.forename: Mauro
authors.initials: M
authors.lastname: Santos
authors.forename: David
authors.initials: D
authors.lastname: Wong
authors.forename: David
authors.initials: D
authors.lastname: Clifton
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Birks
authors.forename: Lionel
authors.initials: L
authors.lastname: Tarassenko
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D058996:Quality Improvement; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D006113:United Kingdom