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‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis
OBJECTIVES: To understand factors associated with errors using an established paper-based early warning score (EWS) system. We investigated the types of error, where they are most likely to occur, and whether ‘errors’ can predict subsequent changes in patient vital signs. METHODS: Retrospective anal...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499704/ https://www.ncbi.nlm.nih.gov/pubmed/26141302 http://dx.doi.org/10.1136/bmjopen-2014-007376 |
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author | Clifton, David A Clifton, Lei Sandu, Dona-Maria Smith, G B Tarassenko, Lionel Vollam, Sarah A Watkinson, Peter J |
author_facet | Clifton, David A Clifton, Lei Sandu, Dona-Maria Smith, G B Tarassenko, Lionel Vollam, Sarah A Watkinson, Peter J |
author_sort | Clifton, David A |
collection | PubMed |
description | OBJECTIVES: To understand factors associated with errors using an established paper-based early warning score (EWS) system. We investigated the types of error, where they are most likely to occur, and whether ‘errors’ can predict subsequent changes in patient vital signs. METHODS: Retrospective analysis of prospectively collected early warning system database from a single large UK teaching hospital. RESULTS: 16 795 observation sets, from 200 postsurgical patients, were collected. Incomplete observation sets were more likely to contain observations which should have led to an alert than complete observation sets (15.1% vs 7.6%, p<0.001), but less likely to have an alerting score correctly calculated (38.8% vs 30.0%, p<0.001). Mis-scoring was much more common when leaving a sequence of three or more consecutive observation sets with aggregate scores of 0 (55.3%) than within the sequence (3.0%, p<0.001). Observation sets that ‘incorrectly’ alerted were more frequently followed by a correctly alerting observation set than error-free non-alerting observation sets (14.7% vs 4.2%, p<0.001). Observation sets that ‘incorrectly’ did not alert were more frequently followed by an observation set that did not alert than error-free alerting observation sets (73.2% vs 45.8%, p<0.001). CONCLUSIONS: Missed alerts are particularly common in incomplete observation sets and when a patient first becomes unstable. Observation sets that ‘incorrectly’ alert or ‘incorrectly’ do not alert are highly predictive of the next observation set, suggesting that clinical staff detect both deterioration and improvement in advance of the EWS system by using information not currently encoded within it. Work is urgently needed to understand how best to capture this information. |
format | Online Article Text |
id | pubmed-4499704 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-44997042015-07-15 ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis Clifton, David A Clifton, Lei Sandu, Dona-Maria Smith, G B Tarassenko, Lionel Vollam, Sarah A Watkinson, Peter J BMJ Open Health Services Research OBJECTIVES: To understand factors associated with errors using an established paper-based early warning score (EWS) system. We investigated the types of error, where they are most likely to occur, and whether ‘errors’ can predict subsequent changes in patient vital signs. METHODS: Retrospective analysis of prospectively collected early warning system database from a single large UK teaching hospital. RESULTS: 16 795 observation sets, from 200 postsurgical patients, were collected. Incomplete observation sets were more likely to contain observations which should have led to an alert than complete observation sets (15.1% vs 7.6%, p<0.001), but less likely to have an alerting score correctly calculated (38.8% vs 30.0%, p<0.001). Mis-scoring was much more common when leaving a sequence of three or more consecutive observation sets with aggregate scores of 0 (55.3%) than within the sequence (3.0%, p<0.001). Observation sets that ‘incorrectly’ alerted were more frequently followed by a correctly alerting observation set than error-free non-alerting observation sets (14.7% vs 4.2%, p<0.001). Observation sets that ‘incorrectly’ did not alert were more frequently followed by an observation set that did not alert than error-free alerting observation sets (73.2% vs 45.8%, p<0.001). CONCLUSIONS: Missed alerts are particularly common in incomplete observation sets and when a patient first becomes unstable. Observation sets that ‘incorrectly’ alert or ‘incorrectly’ do not alert are highly predictive of the next observation set, suggesting that clinical staff detect both deterioration and improvement in advance of the EWS system by using information not currently encoded within it. Work is urgently needed to understand how best to capture this information. BMJ Publishing Group 2015-07-03 /pmc/articles/PMC4499704/ /pubmed/26141302 http://dx.doi.org/10.1136/bmjopen-2014-007376 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Health Services Research Clifton, David A Clifton, Lei Sandu, Dona-Maria Smith, G B Tarassenko, Lionel Vollam, Sarah A Watkinson, Peter J ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis |
title | ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis |
title_full | ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis |
title_fullStr | ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis |
title_full_unstemmed | ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis |
title_short | ‘Errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis |
title_sort | ‘errors’ and omissions in paper-based early warning scores: the association with changes in vital signs—a database analysis |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499704/ https://www.ncbi.nlm.nih.gov/pubmed/26141302 http://dx.doi.org/10.1136/bmjopen-2014-007376 |
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