A quality improvement project to establish accuracy in completing Early Warning Score chart and appropriate clinical response depending on the score in acute care wards at Asiri Surgical Hospital

Abstract

Failure or delay in recognition of acutely deteriorating patients in acute care ward setting leads to preventable morbidity, cardiac arrest, and death. Assessment and responding to Early Warning Score (EWS) adapted from National Early Warning Score 2 is implemented at Asiri Surgical Hospital to capture these patients early and escalate their care appropriately. Though a colour-coded EWS chart and a hospital policy are available, gaps in accurate recording, monitoring, and triggering were reported. Thus, a quality improvement project was conducted with the aim of establishing more than 80% accuracy in completing the EWS chart and appropriate clinical response to EWS score in acute care wards at Asiri Surgical Hospital by August 2022.A multidisciplinary team performed a series of Plan-Do-Study-Act cycles focusing on correct documentation and calculation of EWS score and appropriate monitoring and escalation of care. Key drivers for hindering the pathway were identified and addressed. Over the course of the project, correct recording improved from 81.25% to 99.4%, accurate calculation of total EWS score had improved from 79% to 88%, patients who received recommended monitoring as triggered by EWS score improved from 78.8% to 84.6% and escalation of care when EWS score is 5 or more improved from 70.9% to 91.7%.A step improvement in the clinical response to a deteriorating patient in the acute care ward setting at Asiri Surgical Hospital was attained by the successful quality improvement project involving the frontline care providers.