A single-centre audit of early warning scores and medical emergency team activation in medical and surgical admissions at Wellington Regional Hospital.

Abstract

This single-centre retrospective audit evaluates the accuracy of nurse-documented vital signs and aggregated New Zealand's early warning scores (NZEWS) in high-acuity inpatients, and the proportion who appropriately received medical emergency team (MET) callouts. Eligible patients admitted to general medicine and surgery services in the first 2 days of each month starting January 2022 and ending August 2022 and February 2023, respectively, had every documented vital sign and NZEWS entered into a database until 100 patients with an NZEWS of 6 or greater in the first 24 hours of the admission, or 10 patients with MET callouts per service were identified. We examined NZEWS calculations and their association with MET callout activation. An agreement analysis examined discrepancies between nurse-calculated and audit-calculated NZEWS. Of 491 screened admissions, 63 (12.8%) fulfilled criteria for inclusion and a total of 20 (4.1%) patients had at least 1 MET callout, of 23 who fulfilled MET criteria. Correct calculation and documentation occurred in three quarters (75.8%) of all NZEWS audited. Approximately half (46.8%) of the 47 individual NZEWS instances mandating MET activation resulted in a MET callout and only one in eight (12.8%) had a documented and accurately calculated NZEWS. The mean difference between nurse and audit-calculated NZEWS was -0.19 (nurse minus audit-calculated, with 95% confidence intervals of -0.28 to -0.09) with limits of agreement -3.64 to 3.26. When dependent on manual processes, NZEWS documentation, calculation, and MET activation is suboptimal. Automation of NZEWS and MET callouts requires prioritization.