Bedside vital parameters that indicate early deterioration
International Journal of Health Care Quality Assurance
ISSN: 0952-6862
Article publication date: 11 February 2019
Issue publication date: 11 February 2019
Abstract
Purpose
The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and further clinical deterioration (MEWS level=4).
Design/methodology/approach
This was a prospective study in which 27,504 vital parameter values, corresponding to a total MEWS level⩾2, belonging to 1,315 adult medical and surgical inpatient patients admitted to a 90-bed study setting at a university hospital, were subjected to binary logistic and COX regression analyses to determine associations between vital parameter values initially corresponding to total MEWS levels 2 or 3 and later deterioration to total MEWS level ⩾4, and to evaluate corresponding time intervals.
Findings
Respiratory rate, heart rate and patient age were significantly (p=0.012, p<0.001 and p=0.028, respectively) associated with further deterioration from a total MEWS level 2, and the heart rate also (p=0.009) from a total MEWS level 3. Within 24 h from the initially recorded total MEWS levels 2 or 3, 8 and 17 percent of patients, respectively, deteriorated to a total MEWS level=4. Patients initially scoring MEWS 2 had a 27 percent 30-day mortality rate if they later scored MEWS level=4, and 8.7 percent if they did not.
Practical implications
It is important to observe all patients closely, but especially elderly patients, if total MEWS levels 2 or 3 are tachypnoea and/or tachycardia related.
Originality/value
Findings might contribute to patient safety by facilitating appropriate clinical and organizational decisions on adequate time spans for early warning scoring in general ward patients.
Keywords
Acknowledgements
The authors acknowledge the Copenhagen University Hospital, Hvidovre, Denmark, for supporting this project. The authors also thank department head, all nursing and medical staff at the study setting for their generous participation.
Citation
Bunkenborg, G., Poulsen, I., Samuelson, K., Ladelund, S. and Akeson, J. (2019), "Bedside vital parameters that indicate early deterioration", International Journal of Health Care Quality Assurance, Vol. 32 No. 1, pp. 262-272. https://doi.org/10.1108/IJHCQA-10-2017-0206
Publisher
:Emerald Publishing Limited
Copyright © 2019, Emerald Publishing Limited