Journal Article

Six-day postoperative impact of a standardized nurse observation and escalation protocol: A preintervention and postintervention study

Haegdorens, Filip, Verpooten, Gert A., Van Bogaert, Peter, De Meester, Koen, Holvoet, Annelies, Monsieurs, Koenraad G.

2013

Overview

The purpose of the study is to determine the impact of a standardized nurse observation and escalation protocol on observation frequency, the measurement of vital signs, and the incidence of in-hospital mortality and resurgery. This is a preintervention and postintervention study by analysis of patient records for a 6-day postoperative period of all adult patients hospitalized in 4 hospital wards after surgery during a preintervention (November 2010 to March 2011; n = 2359) and postintervention (November 2011 to March 2012; n = 1888) period implementing a standardized nurse observation and escalation protocol including the Modified Early Warning Score. The mean patient observation frequency per nursing shift increased from 0.9076 (95% confidence interval [CI], 0.8921-0.9231) preintervention to 0.9940 (95% CI, 0.9708-1.0172; P < .001) postintervention and was lower in case of 6-day postoperative mortality (0.6686 [95% CI, 0.4984-0.8388] vs other patients 0.9475 [95% CI, 0.9340-0.9610]; P = .003) or resurgery (0.8402 [95% CI, 0.7894-0.8909] vs other patients 0.9564 [95% CI, 0.9378-0.9657]; P = .003). The mean number of vital signs measured per observation episode increased from a mean of 1.81 (95% CI, 1.79-1.83) preintervention to 2.45 (95% CI, 2.39-2.51; P < .001) postintervention. The relative risk reduction was 73.7% (95% CI, 22.8-91.0; P = .015) for 6-day postoperative in-hospital mortality and 30.9% (95% CI, 9.5-47.2; P = .007) for 6-day postoperative resurgery.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Belgium - epidemiology / Consciousness / Critical Care / Critical Care Nursing - standards / Deteriorating patients / Female / Health care / Hospital Mortality / Hospital Rapid Response Team - organization & administration / Hospitals / Humans / Incidence / Intensive Care Units / Male / Middle Aged / Modified Early Warning Score/MEWS / Monitoring systems / Mortality / Nurses / Nursing / Nursing Assessment - standards / Observation / Postoperative Period / Prospective Studies / Rapid Response System / Reoperation - statistics & numerical data / Retrospective Studies / Studies / Unexpected death / Vital Signs