Faculty Collaboration Database

Effect of Implementing a Commercial Electronic Early Warning System on Outcomes of Hospitalized Patients. Am J Med Qual 2023 Sep-Oct 01;38(5):229-237

Date

09/08/2023

Pubmed ID

37678301

DOI

10.1097/JMQ.0000000000000147

Scopus ID

2-s2.0-85170151971 (requires institutional sign-in at Scopus site)

Abstract

Despite the widespread adoption of early warning systems (EWSs), it is uncertain if their implementation improves patient outcomes. The authors report a pre-post quasi-experimental evaluation of a commercially available EWS on patient outcomes at a 700-bed academic medical center. The EWS risk scores were visible in the electronic medical record by bedside clinicians. The EWS risk scores were also monitored remotely 24/7 by critical care trained nurses who actively contacted bedside nurses when a patient's risk levels increased. The primary outcome was inpatient mortality. Secondary outcomes were rapid response team calls and activation of cardiopulmonary arrest (code-4) response teams. The study team conducted a regression discontinuity analysis adjusting for age, gender, insurance, severity of illness, risk of mortality, and hospital occupancy at admission. The analysis included 53,229 hospitalizations. Adjusted analysis showed no significant change in inpatient mortality, rapid response team call, or code-4 activations after implementing the EWS. This study confirms the continued uncertainty in the effectiveness of EWSs and the need for further rigorous examinations of EWSs.

Author List

Singh S, Laud PW, Crotty BH, Nanchal RS, Hanson R, Penlesky AC, Fletcher KE, Stadler ME, Dong Y, Nattinger AB

Authors

Bradley H. Crotty MD Associate Professor in the Medicine department at Medical College of Wisconsin
Yilu Dong PhD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of Wisconsin
Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Michael Stadler MD Associate Dean, Chief Medical Officer, Associate P in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Critical Care
Heart Arrest
Hospital Rapid Response Team
Hospitalization
Humans
Vital Signs