Effect of National Early Warning Scoring System Implementation on Cardiopulmonary Arrest, Unplanned ICU Admission, Emergency Surgery, and Acute Kidney Injury in an Emergency Hospital, Egypt

The Effect of Modified Early Warning Score (MEWS) and Nursing Guide Application on Postoperative Patient Outcomes: A Randomized Controlled Study

PURPOSE

The aim of this study is to determine the effect of nursing guide application (NGA) on patient outcomes in patients followed up according to the modified early warning score (MEWS) in the postoperative period.

DESIGN

A randomized controlled clinical trial.

METHODS

The sample of the study consisted of 252 patients who underwent surgical intervention under general anesthesia in a university hospital between July 29, 2022, and October 31, 2022.

FINDINGS

Results showed that the development of complications was less in the study group (SG) compared to the control group (CG) during anesthesia (P = .027), in the postanesthesia care unit (PACU) (P = .017), and in the clinic (P = .001). It was found that the duration of stay in PACU in the CG was significantly shorter than in the study group (P < .001), and as the duration of stay in PACU in CG decreased, the MEWS increased (r = -0.201, P = .024). We found that there were fewer patients transferred to the intensive care unit (ICU) after PACU (P = .007), the MEWS was lower, and the number of nursing interventions applied to patients was higher (P < .05).

CONCLUSIONS

In patients followed up according to MEWS, NGA had a positive effect on preventing the development of complications and shortening the intervention time for complications, decreasing ICU admission, decreasing MEWS and increasing the number of nursing interventions. Based on the results, it may be recommended to use MEWS+NGA in the early postoperative period as it positively affects patient outcomes.

Unexpected intensive care unit admission after surgery: impact on clinical outcome

PURPOSE OF REVIEW

This review is focused on providing insights into unplanned admission to the intensive care unit (ICU) after surgery, including its causes, effects on clinical outcome, and potential strategies to mitigate the strain on healthcare systems.

RECENT FINDINGS

Postoperative unplanned ICU admission results from a combination of several factors including patient's clinical status, the type of surgical procedure, the level of supportive care and clinical monitoring outside the ICU, and the unexpected occurrence of major perioperative and postoperative complications. The actual impact of unplanned admission to ICU after surgery on clinical outcome remains uncertain, given the conflicting results from several observational studies and recent randomized clinical trials. Nonetheless, unplanned ICU admission after surgery results a significant strain on hospital resources. Consequently, this issue should be addressed in hospital policy with the aim of implementing preoperative risk assessment and patient evaluation, effective communication, vigilant supervision, and the promotion of cooperative healthcare.

SUMMARY

Unplanned ICU admission after surgery is a multifactorial phenomenon that imposes a significant burden on healthcare systems without a clear impact on clinical outcome. Thus, the early identification of patient necessitating ICU interventions is imperative.

General ward nurses detection and response to clinical deterioration in three hospitals at the Kenyan coast: a convergent parallel mixed methods study

BACKGROUND

In low and middle-income countries like Kenya, critical care facilities are limited, meaning acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to deterioration.

METHODS

This convergent parallel mixed methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the vital signs 24 h before a cardiac arrest (death) occurred was retrieved from patients' medical records. In-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards.

RESULTS

This study reviewed 405 patient records and found most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 h prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points, i.e. four hourly. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs linked to limited availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers.

CONCLUSION

The study showed that nurses did not consistently monitor and record vital signs in the general wards. They also worked in suboptimal ward environments that do not support their ability to promptly detect and respond to clinical deterioration. The findings illustrate the importance of implementation of standardised systems for patient assessment and alert mechanisms for deterioration response. Furthermore, creating a supportive work environment is imperative in empowering nurses to identify and respond to patient deterioration. Addressing these issues is not only beneficial for the nurses but, more importantly, for the well-being of the patients they serve.

The NEWS2 score predicts prolonged hospitalization in the intensive care unit in major surgery patients

Objective

Gynecological malignancies are significant causes of mortality and morbidity in women worldwide. Although surgery is an important treatment method, both the extent of the surgery and the factors related to the patient affect postoperative processes. The National Early Warning Score 2 (NEWS2) is a simple, inexpensive, and safe early warning score developed in 2012 and updated in 2017. Although it is not commonly used in surgical patients, its use in patients who will undergo major surgery may provide insights about the postoperative process. This study investigates the importance of NEWS2 and its relationship in patients with for major gynecologic oncology surgery.

Materials and Methods

Forty-four patients with gynecologic malignancies scheduled for major abdominal surgery were included in this study. Patients with a NEWS-2 score of <3 were included in group 1, and patients with a NEWS-2 score of more than 3 were included in groups 2. NEWS2 Score, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation 2 scores (APACHE 2) were calculated. In addition, postoperative routine clinical and laboratory parameters were evaluated. Operation time, duration of intubation in the intensive care unit (ICU), the length of the intensive care stay, and length of hospitalization were recorded.

Results

Duration of intubation in the ICU in group 1 with a NEWS2 <3 [8.2 (0-18) vs 16.2 (3-39), respectively; p<0.01], ICU length of stay [21.6 (4-27) vs 47.3 (4-113), respectively; p<0.01], length of hospitalization [11.6 (5-56) vs 18.6 (8-67), respectively; p<0.01]. NEWS2 >3 was significantly higher compared to group 2. The SOFA score was significantly higher in group 2 compared with group 1 [1.2±0.5 vs 4.1±1.9; respectively; p<0.01]. In the correlation analysis, the NEWS2 score level was positively correlated with the SOFA score (p<0.001, r=0.81) and hospitalization time (p<0.001, r=0.60) and neutrophil lymphocyte ratio (NLR) (p<0.001, r=0.47).

Conclusion

These findings suggest that the NEWS2 score may be correlated with the length of intensive care intubation, length of intensive care stay, and length of hospitalization. NEWS2 is an effective and simple scoring system that provides information about postoperative outcomes in gynecologic oncology patients scheduled for major surgery.