July 28, 2021 by Philips
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The impact of Early Warning Scoring systems

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Better health outcomes, lower cost of care and improved staff, patient and family experience


Patient deterioration is a significant clinical and financial burden for patients, providers, and healthcare systems.2 Clinicians are increasingly treating older, sicker populations at risk for complications and in-hospital adverse events.3 As the volume of hospitalizations for these patients continues to rise, providers are challenged to manage more acute, resource intensive populations in a resource-constrained environment.3


Compounded with a scarcity of beds in higher acuity care areas, patient status may be underestimated, and patients may be admitted or transferred to lower acuity care areas while still at risk for deterioration and resulting serious adverse events.


This scenario may be attributable to a relative lack of resources in lower acuity settings, a significant decrease in nurse to patient ratios, and/or a lack of care coordination. However, evidence of the signs of patient deterioration may be present 6-24 hours prior to an event.5 For example, 66% of cardiac arrest patients show abnormal signs and symptoms up to 6 hours prior to cardiac arrest, but physicians are only notified 25% of the time.6 Moreover, nursing staff may be unaware of abnormal vital signs in almost 50% of patients in the general [i.e., lower acuity] ward7 as they struggle to manage time pressures and work interruptions throughout their shift.8

Patient deterioration may also result in a significant direct economic burden for providers


Patients experiencing adverse events are associated with higher direct healthcare costs.9 A review of the literature highlights this trend, especially among potentially preventable conditions:


  • Surgical complications were associated with a nearly $20K increase in hospital costs and a pronounced decrease in contribution margin10
  • Median costs associated with sepsis are markedly higher than in non-septic patients per case ($10K United Kingdom, $23K Germany)11
  • $3,580 average cost per day of hospitalization for recipients of cardio pulmonary resuscitation12

In this whitepaper


  • Sizing the problem of patient deterioration
  • The evolution of Early Warning Scoring systems
  • Early Warning Scoring system penetration and guidelines adoption
  • Methods, workflow and conditions for success
  • Benefits associated with Early Warning Scoring systems

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  1. Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP. Intensive Care Society’s APACHE II study in Britain and Ireland - I. Variations in case mix of adult admissions to general intensive care units and impact on outcome. British Medical Journal 1993; 307: 972-7.
  2. Murphy A, Cronin J, Whelan R, Drummond FJ, Savage E, Hegarty J. Economics of Early Warning Scores for identifying clinical deterioration - a systematic review. Ir J Med Sci. 2018; 184 :193-205.
  3. American Hospital Association, Trend Watch Chartbook 2018, available at: www.aha.org/system/files/2018-05/2018-AHA-Chartbook_0.pdf.
  4. HealthGrades, Inc: Third Annual Patient Safety in American Hospitals Study. April 2006. www.protectmasspatients.org/docs/PatientSafetyInAmericanHospitalsStudy2006.pdf
  5. Young MP, Gooder VJ, McBride K, James B, Fisher ES. Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity. J Gen Intern Med. 2003; 18: 77-83.
  6. Rutherford P, Lee B, Greiner A. Transforming Care at the Bedside. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004. (Available on www.IHI.org).
  7. Fuhrmann L, Lippert A, Perner A, Østergaard D. Incidence, staff awareness and mortality of patients at risk on general wards. Resuscitation. 2008; 77(3):325-30.
  8. Monteiro C, Ferreira Machado Avelar A, da Luz Gonçalves Pedreira M. Interruptions of nurses’ activities and patient safety: an integrative literature review. Rev Lat Am Enfermagem. 2015; 23(1): 169–179.
  9. Slawomirski L, Auraaen A, Klazinga N. The economics of patient safety. OECD Report. 2017. Available at www.oecd.org/els/health-systems/The-economics-of-patient-safety-March-2017.pdf.
  10. Healy MA, Mullard AJ, Campbell DA Jr, Dimick JB. Hospital and Payer Costs Associated With Surgical Complications. JAMA Surg. 2016; 151(9):823-830.
  11. Moerer O, Burchardi H. The Cost of Sepsis. ICU Management and Practice. 2004; 4(2). available at www.healthmanagement.org/c/icu/issuearticle/the-cost-of-sepsis, look at primer data
  12. KazaureH,RomanS,SosaJ,A.Population-LevelAnalysisof5620Recipientsof Multiple In-Hospital Cardiopulmonary Resuscitation Attempts, Journal of Hospital Medicine. 2014; 9(1): 29-34.

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