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. 2013 Dec;28(6):1068-74.
doi: 10.1016/j.jcrc.2013.07.061. Epub 2013 Sep 6.

Six-day postoperative impact of a standardized nurse observation and escalation protocol: a preintervention and postintervention study

Koen De Meester  1 , Filip Haegdorens, Koenraad G Monsieurs, Gert A Verpooten, Annelies Holvoet, Peter Van Bogaert
Affiliations

Six-day postoperative impact of a standardized nurse observation and escalation protocol: a preintervention and postintervention study

Koen De Meester et al. J Crit Care. 2013 Dec.

Abstract

Purpose: The purpose of the study is to determine the impact of a standardized nurse observation and escalation protocol on observation frequency, the measurement of vital signs, and the incidence of in-hospital mortality and resurgery.

Methods: This is a preintervention and postintervention study by analysis of patient records for a 6-day postoperative period of all adult patients hospitalized in 4 hospital wards after surgery during a preintervention (November 2010 to March 2011; n = 2359) and postintervention (November 2011 to March 2012; n = 1888) period implementing a standardized nurse observation and escalation protocol including the Modified Early Warning Score.

Results: The mean patient observation frequency per nursing shift increased from 0.9076 (95% confidence interval [CI], 0.8921-0.9231) preintervention to 0.9940 (95% CI, 0.9708-1.0172; P < .001) postintervention and was lower in case of 6-day postoperative mortality (0.6686 [95% CI, 0.4984-0.8388] vs other patients 0.9475 [95% CI, 0.9340-0.9610]; P = .003) or resurgery (0.8402 [95% CI, 0.7894-0.8909] vs other patients 0.9564 [95% CI, 0.9378-0.9657]; P = .003). The mean number of vital signs measured per observation episode increased from a mean of 1.81 (95% CI, 1.79-1.83) preintervention to 2.45 (95% CI, 2.39-2.51; P < .001) postintervention. The relative risk reduction was 73.7% (95% CI, 22.8-91.0; P = .015) for 6-day postoperative in-hospital mortality and 30.9% (95% CI, 9.5-47.2; P = .007) for 6-day postoperative resurgery.

Keywords: Deteriorating patients; Modified Early Warning Score/MEWS; Rapid Response System; Unexpected death; Vital signs.

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