Clinical Application Of Standardized Early Warning Score In Surgical HDU

ObjectiveAccording to the research of Early Warning Scoring Tool (EWS) in recent years, Standardized Early Warning Scoring Tool (SEWS) was developed. To evaluate SEWS’ applicability in surgical ward of a general hospital, and test its reliability and validity. To provide a standardized measurement tool for hospitalized patients’assessment. To analysis the best warning trigger values in High Dependency Unit (HDU) in surgical ward. To explore the scoring tool in the reasonable allocation in order to use the value of care resources and provide theory basis for clinical nursing staff for patients’ evaluation.Methods1SEWS determined by preliminary assessment rating scale, adopted the method of convenience sampling from December2012to February2013in surgical ward of a general hospital in Tianjin. To establish the scale’ validity and reliability, internal consistency, intra-class correlation analysis, factor analysis and content validity were undertaken.2Select183patients in surgical HDU during March2013to December2013as the research object, SEWS was calculated with SIRS which is anther simple scale. To analysis SEWS with the patients’condition changes and prognosis, and compare SEWS and SIRS to differential ability of patients receiving treatment and prognosis. To analysis the early warning trigger value with SEWS. The data is analyzed by SPSS17.0to do the describe analysis, t-test, x2-test, Kruskal-Wallis test and the area under ROC curve calculation.Results1SEWS had higher internal consistency, with Cronbach’s Alpha0.840and ICC0.994(95%CI,0.990to0.997); scale consisted of six items, the exploratory factor analysis of the scale resulted in two principal factors and explained for62.853%variances and each item in its corresponding dimensions are high factor loading; the average score of content validity ratio was0.917.2The incidence of transferred to ICU, death and readmission increased significantly in patients of higher SEWS, compared with low grade (x2=111.429, P<0.001); SEWS≥4of patients transferred to ICU and death significantly increased (x2=36.378, P<0.001); median length of stay extended significantly in relation to increasing SEWS score, which a score of≥4as opposed to0-3equated with more than a doubling of length of stay (the average rank are65.50and152.50respectively, x2=146.554, P<0.001); for the treatment of ICU patients with SEWS and SIRS score area under the ROC curve are0.859and0.767respectively, with medium range resolution to patients’condition, and comparing the area under the curve shows SEWS has higher sensitivity and specificity (Z=3.07, P<0.05), while SEWS assessment boundary value was four points, Youden index was0.619, sensitivity was91.3%and specificity was70.6%; two scale for risk prediction of mortality in patients under ROC curve area were0.888and0.784respectively with moderate range resolution, yet the area under the curve has no significant difference, while SEWS assessment boundary value was eight points, Youden index was0.691, sensitivity was71.4%and specificity was97.7%.ConclusionsSEWS scale has good reliability and validity which works in surgical ward, and it is an effective tool for evaluation of hospitalized patients with surgical disease risk; with the increase of scores, the higher risk of transferred to ICU or death, length of stay and care unit stay may extend; with four points divided into early warning trigger value, patients may need to improve the level of care or admitted to ICU should be considered, and eight points may increase risk of death; nurse can evaluate in-patients as the basis of improving the monitoring level to ensure patient safety according to SEWS scale.