Implementation of an automated early warning scoring system in a surgical ward: practical use and effects on patient outcomes

Introduction: Early warning scores (EWS) are being increasingly embedded in hospitals over the world due to their promise to reduce adverse events and improve the outcomes of clinical patients. The aim of this study was to evaluate the clinical use of an automated modified EWS (MEWS) for patients after surgery. Methods: This study conducted retrospective before-and-after comparative analysis of non-automated and automated MEWS for patients admitted to the surgical high-dependency unit in a tertiary hospital. Operational outcomes included number of recorded assessments of the individual MEWS elements, number of complete MEWS assessments, as well as adherence rate to related protocols. Clinical outcomes included hospital length of stay, in-hospital and 28-day mortality, and ICU readmission rate. Results: Recordings in the electronic medical record from the control period contained 7929 assessments of MEWS elements and were performed in 320 patients. Recordings from the intervention period contained 8781 assessments of MEWS elements in 273 patients, of which 3418 were performed with the automated EWS system. During the control period, 199 (2.5%) complete MEWS were recorded versus 3991 (45.5%) during intervention period. With the automated MEWS systems, the percentage of missing assessments and the time until the next assessment for patients with a MEWS of ≥2 decreased significantly. The protocol adherence improved from 1.1% during the control period to 25.4% when the automated MEWS system was involved. There were no significant differences in clinical outcomes. Conclusion: Implementation of an automated EWS system on a surgical high dependency unit improves the number of complete MEWS assessments, registered vital signs, and adherence to the EWS hospital protocol. However, this positive effect did not translate into a significant decrease in mortality, hospital length of stay, or ICU readmissions. Future research and development on automated EWS systems should focus on data management and technology interoperability.

引言：早期预警评分（Early Warning Scores, EWS）凭借其降低不良事件发生率、改善临床患者预后的潜力，目前在全球医院中的应用日益广泛。本研究旨在评估自动化改良早期预警评分（Modified Early Warning Scores, MEWS）在术后患者中的临床应用价值。
方法：本研究针对某三级医院外科高依赖病房收治的患者，采用回顾性前后对照分析，对比非自动化与自动化改良早期预警评分的应用效果。本研究的操作结局指标包括：单项MEWS要素的记录次数、完整MEWS评分完成次数，以及相关临床规范的依从率。临床结局指标包括：住院时长、院内及28天死亡率，以及ICU再入院率。
结果：对照期电子病历中共记录7929项MEWS要素评分，涉及320例患者。干预期共记录8781项MEWS要素评分，涉及273例患者，其中3418项评分通过自动化EWS系统完成。对照期完整MEWS评分记录共199项（占比2.5%），干预期则为3991项（占比45.5%）。使用自动化MEWS系统后，MEWS评分≥2分患者的评分缺失占比与两次评分间隔时长均显著降低。临床规范依从率从对照期的1.1%提升至启用自动化MEWS系统后的25.4%。两组临床结局指标无显著差异。
结论：在外科高依赖病房部署自动化EWS系统，可提升完整MEWS评分记录数量、生命体征登记完成率以及对EWS院内临床规范的依从性。但该积极效应并未转化为死亡率、住院时长或ICU再入院率的显著降低。未来自动化EWS系统的研发应聚焦于数据管理与技术互操作性。