Early warning scores: implementation, challenges and solutions within the initiative of quality in medicine

Abstract

Background: In hospitalised patients, clinical deterioration can be detected at an early stage using early warning scores (EWS), enabling timely interventions. However, it remains unclear to what extent EWS have been implemented within the network of the Initiative of Quality in Medicine (IQM), comprising 480 hospitals, and what facilitating and challenging factors have been reported in this context. Methods: An online survey within the IQM was conducted to assess EWS-specific structures and processes, barriers, and facilitators. The degree of implementation was self-rated by participants on a numerical rating scale from 1 to 10 (10 = maximum). Results: Of the 480 individuals contacted, 18.7% (n = 90) responded; 6.3% (n = 30) reported using EWS in clinical practice for an average of 4.3 years. Among these, the National-EWS (NEWS) was most frequently used (37.9%, n = 11), primarily on general medical wards (66.7%, n = 20). Rapid response teams were mostly formed by resuscitation teams (33.3%, n = 10). Electronic systems were used for EWS recording in 82.2% (n = 24), and documentation was most often performed in response to clinical abnormalities (56.7%, n = 17). The self-rated median implementation score was 3.5. The top three facilitating factors included committed staff, clear communication and training strategies, and technological support; barriers identified were lack of staff acceptance, insufficient technical infrastructure, and time required for training. Conclusion: The implementation of EWS within the IQM appears to be limited and might be a challenging and complex process. The low participation rate limits the informative value of this study.