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The "early-warning" scores (modified or otherwise!) were developed to assist ward staff who do not normally deal with very ill patients as a regular part of their jobs and who might therefore miss the early signs of a patient who is deteriorating.

The idea is that hospitals should now be running "Medical Emergency Teams" (MET) instead of the old-fashioned "Cardiac Arrest Teams" (i.e. why wait until the patient arrests and prognosis is DIRE, why not try to spot the sick ones EARLY and get a better outcome...?) and an early-warning scoring system is simply an aid to help the ward staff decide when to request such assistance.

They are a very simple idea that assigns numerical values to basic physiological variables (resp rate, pulse, BP, temp... all the usual stuff) and the score should be calculated and recorded EVERY time obs are taken by nursing staff or HCAs.

Usually there is a threshold score which requires the ward staff to report the patient's condition and triggers a level of medical review and/or intervention (as required). Some hospitals even have several threshold levels; e.g. repeated low scores = review by HO/SHO; moderate score = review by ICU outreach nurse +/- medical registrar; high score = immediate call to MET.

The pre-hospital use of these is an interesting idea but overall I'm not sure there's a huge amount of benefit to be added by squeezing yet another score onto a PRF. As part of a handover it may not be particularly relevant at all because different hospitals use different approaches to scoring and the threshold scores will vary depending on how the score is calculated. The Emergency Departments often don't use them anyway.

For staff who regularly deal with ill patients the idea should be to develop observational patient assessment skills and an understanding of sick patients, not to rely on a score that is designed for people not used to acute care. As Carrot says, it's about taking the OVERALL picture into account and LOOKING at the PATIENT!! The scores are a good guide for getting less experienced or less well qualified staff to call for help early. They are not, however, a stand-alone decision-making tool.

Having said that, where it will be useful is that it may help newer or less confident ambulance staff to decide how ill a patient is until they gain more experience of patient assessment. In that respect, I'd say it was more useful as a quick guide to us than as an absolute indicator to the hospital.

Does that make sense?

Quote:

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look at yer patient.

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EVERY time!!!