Effect of the national early warning score on monitoring the vital signs of patients in the emergency room

Oliveira, Gabriella Novelli; Nogueira, Lilia de Souza; Cruz, Diná de Almeida Lopes Monteiro da

doi:10.1590/1980-220X-REEUSP-2021-0445en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 (spe) • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0445en copy

Effect of the national early warning score on monitoring the vital signs of patients in the emergency room^* * Extracted from the thesis: “Efeito do uso do National Early Warning Score (NEWS) em pronto-socorro na evolução clínica dos pacientes”, Universidade de São Paulo, Escola de Enfermagem, 2021.

Efecto del national early warning score en el monitoreo de los signos vitales de los pacientes en urgencias

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To verify the effect of using the National Early Warning Score (NEWS) system on the compliance of the vital signs monitoring interval with those recommended for patients in the emergency room.

Methods:

This is a quasi-experimental, before-and-after study, performed in an emergency room with 280 adult patients selected by convenience. The effect of NEWS on the compliance of the vital signs monitoring interval with those recommended by the system was analyzed by linear regression.

Results:

In the Pre-NEWS phase, 143 patients were analyzed (mean age ± standard deviation: 54.4 ± 20.5; male: 56.6%) and, in the Post-NEWS phase, 137 patients (mean age ± standard deviation: 55.5 ± 20.8; male: 50.4%). There was compliance of the vital signs monitoring interval with what is recommended by NEWS in 92.6% of vital signs records after adopting this instrument. This compliance was 9% (p < 0.001) higher in the Post-NEWS phase.

Conclusion:

The use of the NEWS system increased the compliance of the vital signs monitoring intervals with the ones recommended, but this compliance decreased when the NEWS score pointed to a shorter interval in the monitoring of vital signs.

DESCRIPTORS
Vital Signs; Early Warning Score; Clinical Deterioration; Nursing Care; Emergency Service, Hospital

Variables		Pre-NEWS (n = 143)	Post-NEWS (n = 137)	P-value
Sex, n (%)	Female	62 (43.4)	68 (49.6)	0.293*
	Male	81 (56.6)	69 (50.4)
Age, years	Minimum-maximum	19–94	18–97
	Mean ± SD	54.4 (20.5)	55.5 (20.8)	0.614^†
	Median	55	58
	95%CI	51.1–57.8	52.0-58.9
Comorbidities (CCI)	Minimum-maximum	0–10	0–7	0.637^†
	Mean ± SD	1.6 (2.3)	1.4 (2.1)
	Median	0	0
	95%CI	1.2–2.0	1.1–18
Main complaint, n (%)	Pain	59 (41.2)	60 (43.8)	0.023*
	Trauma	30 (21.0)	43 (31.4)
	Dyspnea	27 (18.9)	9 (6.6)
	Neurological	15 (10.5)	13 (9.5)
	Others	12 (8.4)	12 (8.7)
Medical specialty	Internal medicine	63 (44.0)	36 (26.3)	0.002*
	Surgery	80 (56.0)	101 (73.7)

Variable	Pre-NEWS (n = 900) n (%)	Post-NEWS (n = 767) n (%)	P-value
NEWS recommended intervals for monitoring vital signs			<0.001*
Every 12 hours	575 (63.9)	282 (36.8)
4-6 hours	291 (32.3)	377 (49.2)
Every hour	33 (3.7)	85 (11.0)
Continually	1 (0.1)	23 (3.0)
Compliance of the vital signs monitoring interval with the one recommended by NEWS			<0.001*
According to NEWS	181 (20.1)	710 (92.6)
Shorter interval	607 (67.5)	20 (2.6)
Longer interval	112 (12.4)	37 (4.8)

Model: NEWS compliance	Coefficient	SE	95%CI	P-value	GVIF
Intercept	0.96	0.03	0.90–1.02	<0.001
Post-NEWS Phase	0.09	0.02	0.05–0.13	<0.001	1.11
NEWS on admission 1 to 4	−0.10	0.02	−0.14–−0.06	<0.001	1.03
NEWS on admission 5 to 6	−0.15	0.04	−0.23–−0.07	<0.001
NEWS on admission 3	−0.73	0.06	−0.85–−0.61	<0.001
NEWS on admission 7 or more	−0.11	0.04	−0.20–−0.02	0.010
Internal medicine	0.01	0.02	−0.03–0.05	0.594	1.13
Male	−0.02	0.01	−0.05–0.01	0.263	1.01
Age	0.00	0.00	−0.00–0.00	0.634	1.25
CCI	0.00	0.00	−0.00–0.01	0.491	1.27

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Gabriella Novelli Oliveira Av. Prof. Lineu Prestes, 2565 Cidade Universitária 05508-000 – Butantã, São Paulo, SP, Brazil novellioliveira@gmail.com