A new situation awareness model decreases clinical deterioration in the emergency departments-A controlled intervention study
| Autor: | Marianne Lisby, Nikolaj Raaber, Mette Trøllund Rask, Gitte Boier Tygesen, Hans Kirkegaard |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty early warning score Vital signs Affect (psychology) Odds law.invention 03 medical and health sciences 0302 clinical medicine track and trigger system law emergency medicine Intervention (counseling) medicine Humans 030212 general & internal medicine Hospital Mortality Clinical Deterioration business.industry 030208 emergency & critical care medicine General Medicine Emergency department Awareness Early warning score Intensive care unit Intensive Care Units Anesthesiology and Pain Medicine Emergency medicine clinical deterioration business Risk assessment Emergency Service Hospital |
| Zdroj: | Tygesen, G B, Lisby, M, Raaber, N, Rask, M T & Kirkegaard, H 2021, ' A new situation awareness model decreases clinical deterioration in the emergency departments—A controlled intervention study ', Acta Anaesthesiologica Scandinavica, vol. 65, no. 9, pp. 1337-1344 . https://doi.org/10.1111/aas.13929 |
| ISSN: | 1399-6576 |
| DOI: | 10.1111/aas.13929 |
| Popis: | Background: Studies have suggested that adding subjective parameters to early warning score (EWS) systems might prompt more proactive treatment and positively affect clinical outcomes. Hence, the study aimed to investigate effect of a situation awareness model consisting of objective and subjective parameters on clinical deterioration in adult emergency department (ED) patients. Methods: This controlled pre-and-post interventional study was carried out in July–December 2016 and November 2017–April 2018. In ED patients ≥ 18 years, we examined if a situation awareness model compared with a conventional EWS system could reduce clinical deterioration. The new model consisted of a regional EWS, combined with skin observation, clinical concern and patients’ and relatives’ concerns, pain, dyspnea, and team risk assessment. Clinical deterioration was defined as change in vital signs requiring increased observation or physician assessment, that is, increase in early warning score from either 0 or 1 to score ≥2 or an increase from score ≥2 and above. Secondary outcomes were mortality, intensive care unit (ICU) admissions, and readmissions. Results: We included 34 556 patients. Patients with two or more registered EWS were included in the primary analysis (N = 21 839). Using difference-in-difference regression, we found a reduced odds of clinical deterioration of 21% (OR 0.79 95% CI [0.69; 0.90]) in the intervention groups compared with controls. No impact on mortality, ICU, or readmissions was found. Conclusion: The situation awareness model reduces odds of clinical deterioration, defined as a clinically relevant increase in EWS, in an unselected adult population of ED patients. However, there was no effect on secondary outcomes. |
| Databáze: | OpenAIRE |
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