title: Using Quality Improvement to Introduce and Standardize the National Early Warning Score (NEWS) for Adult Inpatients at a Children's Hospital.
abstract: The population of adults with childhood-onset chronic illness is growing across children's hospitals and constitutes a high risk population. National Early Warning Score (NEWS) is among the most recently validated adult early warning scores (EWSs) for early recognition of and response to clinical deterioration. Our aim was to implement and standardize NEWS scoring in 80% of patients age 21 and older admitted to a children's hospital.
  
  
  
  Our intervention was tested on a single unit of our children's hospital. The primary process measure was the percentage of NEWS documented within 1 hour of routine nursing assessments, and was tracked using a run chart. Improvement activities focused on effective training, key stakeholder buy-in, increased awareness, real-time mitigation of failures, accountability for adherence, and action-oriented response. We also tracked the distribution of NEWS values and medical emergency team calls.
  
  
  
  The percentage of NEWS documented with routine nursing assessments for patients age 21 and over increased from 0% to 90% within 15 weeks and remained at 77% or greater for 17 weeks. Our distribution of NEWS values was similar to previously reported NEWS distribution.
  
  
  
  A nurse-driven adult early warning system for inpatients age 21 and older at a children's hospital can be achieved through a standardized EWS assessment process, incorporation into the electronic health record, and charge nurse and key stakeholder oversight. Furthermore, implementation of an adult EWS being used at a pediatric institution and our distribution of NEWS values were comparable to distribution published from adult hospitals.
authors.affiliation: Division of Hospital Medicine, erin.conway@cchmc.org.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Conway-Habes
authors.affiliation: Division of Hospital Medicine.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Herbst
authors.affiliation: Division of Hospital Medicine.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Herbst
authors.affiliation: Division of Hospital Medicine.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kinnear
authors.affiliation: Division of Hospital Medicine.
authors.forename: Kristen
authors.initials: K
authors.lastname: Timmons
authors.affiliation: Clinical Affairs, and.
authors.forename: Deborah
authors.initials: D
authors.lastname: Horewitz
authors.affiliation: Complex Surgery and Transplant, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Rachel
authors.initials: R
authors.lastname: Falgout
authors.affiliation: Division of Hospital Medicine.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: O'Toole
authors.affiliation: Division of Hospital Medicine.
authors.forename: Michael
authors.initials: M
authors.lastname: Vossmeyer
mesh_terms: D000328:Adult; D000465:Algorithms; D002908:Chronic Disease; D057286:Electronic Health Records; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D008875:Middle Aged; D009730:Nursing Assessment; D009820:Ohio; D015397:Program Evaluation; D058996:Quality Improvement; D018570:Risk Assessment; D012720:Severity of Illness Index; D055986:Vital Signs; D055815:Young Adult