Date of Award

Spring 2015

Project Type


Program or Major


Degree Name


First Advisor

Susan J Fetzer

Second Advisor

Andrew Watt

Third Advisor

Colette Tilton


Early warning score tools are used in many countries and healthcare settings to collate clinical assessment parameters and translate them into a language that can be used to predict the clinical deterioration of patients. These tools are used in spite of many conflicting studies regarding their validity, reliability and effectiveness. In this quality improvement project an early warning score was embedded in the electronic medical record at one community hospital. The purpose was to facilitate an early response by nurses to changes in patients' assessments through alert messages programmed into the electronic medical record. Phase I of the project involved a pilot unit as an initial test of the early warning score tool. Phase I findings demonstrated an 80% reduction in the number of patients being transferred to the intensive care unit following a rapid response team call. It also demonstrated the same 80% reduction in the number of patients being admitted to the intensive care unit in a state of serious clinical deterioration. In Phase II, the project was extended to all medical surgical units with the addition of two alternative methods for communicating alerts to nurses. In Phase II nurse response times to EWS alerts improved over 80% (p < 0.001), while the number of unplanned transfers of patients to the intensive care unit without and with signs of serious clinical deterioration increased from 1.96 to 3.33 per 1,000 patient days and from 1.14 to 1.67 per 1,000 patient days, respectively. Phased implementation of an early warning score tool led to fewer unplanned ICU transfers (Phase I) and improved response time to early warning score alerts (Phase II).

Available for download on Monday, April 01, 2115