1st September 2017, Volume 130 Number 1461

Kevin Niall Peek, Michael Gillham

An early warning score (EWS) is a tool used by medical providers to identify those patients who are at risk of developing organ dysfunction and/or death. These scores are based…

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Summary

Physical observations are recorded on patients in hospital in order to detect those whose conditions are deteriorating before a medical emergency, such as cardiac arrest, takes place. After heart surgery, the observations are often deranged, especially heart rate, and although rapid treatment is required it would be a significant burden on the medical emergency team to call a “code” in each case. We propose that it would likely be safe to adopt the New Zealand Early Warning Score system in our institution and to increase the heart rate parameter from 140 to 150 beats per minute.

Abstract

Aim

The rate of medical emergency team (MET) calling among post-cardiac surgery patients is unknown. We set out to determine what the call frequency would be if MET activation occurred in every instance that the early warning score (EWS) breached our local threshold, what the outcome was for these patients and what the calling rate might be if the proposed New Zealand EWS (NZEWS) system was implemented with 100% adherence.

Method

The clinical records of 400 consecutive post-cardiac surgery patients were examined. The number of times a patient’s EWS reached the threshold which mandated a call to the MET was determined, as was the actual rate of calling, the occurrence of inpatient death and re-admission to the intensive care unit (ICU). The rate of calling was then determined using the NZEWS, and with a routine modification to the heart rate score.

Results

There were 73 occasions (MET events) where the EWS reached the MET calling threshold. The MET was only called twice. There were no inpatient deaths and 12 ICU re-admissions in the study cohort. Nine ICU re-admissions were preceded by a MET event, two by cardiac arrest and one had neither. Re-scoring with NZEWS yielded 53 events. Eight of the 12 ICU admissions were preceded by a NZEWS event.

Conclusion

The rate of MET triggering EWS in patients post-cardiac surgery is high at 182/1,000 admissions. Using NZEWS could reduce the MET calling rate without significant risk to patient safety.

Author Information

Kevin Niall Peek, Auckland District Health Board, Auckland; Michael Gillham, Cardiothoracic and Vascular Intensive Care and High Dependency Unit. Auckland District Health Board, Auckland.

Acknowledgements

The authors would like to acknowledge the help given by Dr Alastair McGeorge in managing the CVICU database. 

Correspondence

Kevin Niall Peek, Cardiothoracic and Vascular Intensive Care and High Dependency Unit, Level 4, Building 32, Auckland City Hospital, Park Road, Grafton, Auckland.

Correspondence Email

peeke318@gmail.com

Competing Interests

Nil.

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