Early warning score

From WikiLectures

Early warning score (EWS) is a tool to detect critically endangered patients based on changes in vital signs. It was created in the 1990s to prevent cardiac arrest.

Score 3 2 1 0 1 2 3
Number of breaths/min >35 31-35 21-30 9-20 <7
SpO2 (%) <85 85-89 90-92 >92
Temperature (C) >38.9 38-38.9 36-37.9 35-35.9 34-34.9 <34
Systolic pressure (mmHg) >199 100-199 80-99 70-79 <70
Heart rate/min >129 110-129 100-109 50-99 40-49 30-39 <30
Consciousness Vigilant Addressable Reaction to pain Unresponsive

Based on the overall EWS score, the next step is determined. The reaction to the number of points achieved in the EWS system varies in different medical facilities, but the basic recommendations are:

  • Score greater than 0:
Inform the station nurse or the nurse who leads the shift.
  • Score 1-3:
Monitor EWS at least every 4 hours, consider informing the doctor.
  • Score 3 in any individual category:
Contact and consult a doctor.
Monitor EWS at least once per hour.
  • Score 3-5:
Contact the attending physician and request an acute examination.
If the attending physician is unavailable, contact another physician.
Increase EWS monitoring frequency to 30 minute interval.
  • Score greater than 6:
Call a doctor for an urgent examination.
Frequency of monitoring EWS every 15 minutes.

In the Czech republic, the attending doctor is contacted during working hours and the doctor on duty during duty hours or at the weekend. In some countries (in Australia and New Zealand, but also in Europe, USA), specialized teams of medical professionals (Medical Emergency Team MET) have been introduced. This team usually consists of intensive care unit staff (usually 2 doctors and 1 nurse). The MET attends clinically unstable patients upon referral by standard ward staff. MET call criteria often include EWS.

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