A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response time
Background: The National Early Warning Score (NEWS) is a vital-signs point summation system developed to identify patients at risk of adverse events including cardiac arrests, unplanned ICU admissions, and deaths. The points are usually calculated by the Electronic Health Record after charting, reco...
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Elsevier
2025-05-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520425000840 |
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| author | Raúl J. Gazmuri Rebecca Bieber Calis Lim Mylene Apigo Ma Lea Martin |
| author_facet | Raúl J. Gazmuri Rebecca Bieber Calis Lim Mylene Apigo Ma Lea Martin |
| author_sort | Raúl J. Gazmuri |
| collection | DOAJ |
| description | Background: The National Early Warning Score (NEWS) is a vital-signs point summation system developed to identify patients at risk of adverse events including cardiac arrests, unplanned ICU admissions, and deaths. The points are usually calculated by the Electronic Health Record after charting, recommending local actions and Rapid Response System (RRS) activation when reaching ≥ 7 points. NEWS, however, lacks consistent evidence that it improves outcome and may lead to alarm fatigue. At our institution we operate a Single Early Warning Signs (SEWS) system for RRS activation with a broader range of abnormal signs, without point summation, and bedside assessment within 10 min. Methods: We analyzed 182 RRS activations using SEWS from July 1, 2022, to August 21, 2023, and compared the activation thresholds and dispositions that would have occurred had NEWS been used. Findings: At the time of RRS activation using SEWS, only 10 patients (5.5%) had scored ≥ 7 NEWS points. Of the remaining 172 patients, 158 (86.8%) scored 0 to 4 NEWS points considered low risk and 14 (7.7%) scored 5 to 6 NEWS points considered medium risk (p < 0.001). Yet, 122 patients (67%) were transferred to a higher level of care including 58 patients (31.8%) to ICU. The median in-hospital cardiac arrest during the reported period was 0.8 per 1000 hospital admissions, which is substantially lower than reported rates. Conclusion: SEWS operating with a broader clinical scope, lower activation threshold, and faster RRS activation outperformed NEWS markedly reducing in-hospital cardiac arrests. |
| format | Article |
| id | doaj-art-8fcbffab7eeb4206ac140aceccd88adc |
| institution | Kabale University |
| issn | 2666-5204 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj-art-8fcbffab7eeb4206ac140aceccd88adc2025-08-20T03:53:56ZengElsevierResuscitation Plus2666-52042025-05-012310094710.1016/j.resplu.2025.100947A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response timeRaúl J. Gazmuri0Rebecca Bieber1Calis Lim2Mylene Apigo3Ma Lea Martin4Critical Care Section at the CAPT James A. Lovell Federal Health Care Center, North Chicago, IL, United States; Resuscitation Institute at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States; Corresponding author at: Resuscitation Institute Rosalind Franklin University of Medicine and Science 3333 Green Bay Rd., North Chicago, IL 60064, United States.Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United StatesChicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United StatesCritical Care Section at the CAPT James A. Lovell Federal Health Care Center, North Chicago, IL, United StatesCritical Care Section at the CAPT James A. Lovell Federal Health Care Center, North Chicago, IL, United StatesBackground: The National Early Warning Score (NEWS) is a vital-signs point summation system developed to identify patients at risk of adverse events including cardiac arrests, unplanned ICU admissions, and deaths. The points are usually calculated by the Electronic Health Record after charting, recommending local actions and Rapid Response System (RRS) activation when reaching ≥ 7 points. NEWS, however, lacks consistent evidence that it improves outcome and may lead to alarm fatigue. At our institution we operate a Single Early Warning Signs (SEWS) system for RRS activation with a broader range of abnormal signs, without point summation, and bedside assessment within 10 min. Methods: We analyzed 182 RRS activations using SEWS from July 1, 2022, to August 21, 2023, and compared the activation thresholds and dispositions that would have occurred had NEWS been used. Findings: At the time of RRS activation using SEWS, only 10 patients (5.5%) had scored ≥ 7 NEWS points. Of the remaining 172 patients, 158 (86.8%) scored 0 to 4 NEWS points considered low risk and 14 (7.7%) scored 5 to 6 NEWS points considered medium risk (p < 0.001). Yet, 122 patients (67%) were transferred to a higher level of care including 58 patients (31.8%) to ICU. The median in-hospital cardiac arrest during the reported period was 0.8 per 1000 hospital admissions, which is substantially lower than reported rates. Conclusion: SEWS operating with a broader clinical scope, lower activation threshold, and faster RRS activation outperformed NEWS markedly reducing in-hospital cardiac arrests.http://www.sciencedirect.com/science/article/pii/S2666520425000840Clinical deteriorationElectronic health recordIn-hospital cardiac arrestNational early warning scoreRapid response systemsVital signs |
| spellingShingle | Raúl J. Gazmuri Rebecca Bieber Calis Lim Mylene Apigo Ma Lea Martin A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response time Resuscitation Plus Clinical deterioration Electronic health record In-hospital cardiac arrest National early warning score Rapid response systems Vital signs |
| title | A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response time |
| title_full | A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response time |
| title_fullStr | A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response time |
| title_full_unstemmed | A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response time |
| title_short | A single early warning signs (SEWS) system for recognizing clinically deterioration outperforms the national early warning score (NEWS) by having a lower activation threshold, broader clinical scope, and faster response time |
| title_sort | single early warning signs sews system for recognizing clinically deterioration outperforms the national early warning score news by having a lower activation threshold broader clinical scope and faster response time |
| topic | Clinical deterioration Electronic health record In-hospital cardiac arrest National early warning score Rapid response systems Vital signs |
| url | http://www.sciencedirect.com/science/article/pii/S2666520425000840 |
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