title: Validation of the Intensive Care Unit Early Warning Dashboard: Quality Improvement Utilizing a Retrospective Case-Control Evaluation.
abstract: Risk stratification with the Modified Early Warning System (MEWS) or electronic cardiac arrest trigger (eCART) has been utilized with ward patients to preemptively identify high-risk patients who might benefit from enhanced monitoring, including early intensive care unit (ICU) transfer. In-hospital mortality from cardiac arrest is ∼80%, making preventative interventions an important focus area. ICUs have lower patient to nurse ratios than wards, resulting in less emphasis on the development of ICU early warning systems.
  
  
  
  Our institution developed an early warning dashboard (EWD) identifying patients who may benefit from earlier interventions. Using the adverse outcomes of cardiac arrest, ICU mortality, and ICU readmissions, a retrospective case-control study was performed using three demographic items (age, diabetes, and morbid obesity) and 24 EWD measured items, including vital signs, laboratory values, ventilator information, and other clinical information, to validate the EWD.
  
  
  
  Ten statistically significant areas were identified for cardiac arrest and 13 for ICU death. Identified items included heart rate, dialysis, leukocytosis, and lactate. The ICU readmission outcome was compared to controls from both ICU patients and ward patients, and statistical significance was identified for respiratory rate >30.
  
  
  
  With several statistically significant data elements, the EWD parameters have been incorporated into advanced clinical decision algorithms to identify at-risk ICU patients.
  
  
  
  Earlier identification and treatment of organ failure in the ICU improve outcomes and the EWD can serve as a safety measure for both at-risk in-house patients and also extend critical care expertise through telemedicine to smaller hospitals.
authors.affiliation: 1 Department of Infectious Disease/Critical Care Medicine, Naval Medical Center Portsmouth , Portsmouth, Virginia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kavanaugh
authors.affiliation: 2 Department of Internal Medicine, Naval Medical Center San Diego , California.
authors.forename: Joanne D
authors.initials: JD
authors.lastname: So
authors.affiliation: 3 Department of Emergency Medicine, Naval Medical Center San Diego , California.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Park
authors.affiliation: 4 Department of Pulmonary/Critical Care, Naval Medical Center San Diego , California.
authors.forename: Konrad L
authors.initials: KL
authors.lastname: Davis
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D016022:Case-Control Studies; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000453:epidemiology; D003956:Dialysis / Q000706:statistics & numerical data; D005260:Female; D006305:Health Status Indicators; D006323:Heart Arrest / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D019344:Lactic Acid / Q000097:blood; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D019344:Lactic Acid
keywords: military medicine; technology; telehealth; telemedicine; telenursing