We believe that most cardiac arrests in an acute care setting should be considered a failure to rescue. Despite the introduction of the critical care response team at the Hamilton General Site nine years ago with many successful rescues, we had not seen a sustained impact on in-hospital arrests. In addition, the Juravinski Hospital did not have a response team. The result was an average cardiac/respiratory arrest rate in 2012 of approximately 1/month for the General Site but up to 7 /month for the Juravinski Site.
A pilot study in 2010-2011 demonstrated that using an early warning score in the electronic medical record to track vital signs and trigger a call to the response team was feasible and could reduce cardiac arrests. Therefore the aim of this project was to improve the client experience through timely attention to abnormal vital signs.
The Hamilton Early Warning Score (HEWS), is a modification of previously published early warning scores, with the addition of a trigger for delirium. The score is created within the electronic medical record when nursing staff enter the patient’s vital signs. A screen pops up based on the score to guide the nurse to: increase the monitoring of the patient’s vital signs, call a member of the medical team or call the response team. As part of this initiative we also mandated that the most responsible physician be notified for a score of 6 (equivalent to 3 critical vital signs) as per the College of Physician and Surgeons of Ontario policy for training physicians.
We have now introduced this on all non-critical care acute care wards at the General Site, on the medical and general surgical wards at the Juravinski site and a paper version will be initiated at the West Lincoln Site. The full expansion at the Juravinski site will be aided by a long awaited MD-lead response team in July 2014. We are also introducing the early warning score in the emergency departments, linked to the Canadian Triage Assessment System (CTAS) and for clients who are awaiting a ward bed. A pediatric version of the score is under development.
Throughout this process, the impact on inpatient arrests, unplanned intensive care unit (ICU) admissions and unexpected deaths has been evaluated. Early results demonstrate an increased attention to client safety through increased and earlier calls resulting in less need for an unplanned ICU admission or return to ICU after a critical illness. Our preliminary data suggests that the combination of HEWS and a response team is best for client outcomes.
Title: Physician Lead HEWS project and Site Lead Cardiac
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