Using an Early Warning Score System in the acute medicine unit of a medical city in Saudi Arabia is feasible and reduces admissions to Intensive care.

Mohammad A. ALQahtani, Rajkumar Rajendram, Salih Binsalih, Thari Al Anazi, Naji Al Johani, Ali Al Khathaami, Ahmed Alamry, Mosaad Almegren


Background: Early Warning Scoring Systems (EWSS) are based on vital signs that are intended to help in detecting and defining clinical deterioration. Several studies have demonstrated that when combined with a system of prompt and appropriate clinical responses, the use of EWSS does improve the overall outcome. However, there are very few high-quality studies and the literature is somewhat contradictory. Moreover, no study has yet been conducted on EWSS in the hospitals of Middle East.
Methods: A cross-sectional study was performed on the use of the Physiological Early Warning System (PEWS) in the Acute Medicine Unit (AMU) of a large tertiary hospital (1500 bed medical city) in Saudi Arabia.
Results: The study demonstrated that the use of PEWS was feasible in this setting without ward-based medical cover. PEWS did not affect the average length of stay of patient. Similarly, Critical Care Response Team (CCRT) activation was not reduced. However, admission rate to the intensive care unit (ICU) was significantly reduced.
Conclusion: The studied data suggest that the use of EWSS in this clinical setting improved the responses to deteriorating patients by primary teams and thereby reduced admissions to ICU. However, CCRT involvement was not reduced because the PEWS escalation algorithm overlaps with that for CCRT activation. Further studies are required to determine whether the use of EWSS can improve outcomes whilst reducing the need for CCRT and thereby the costs of treating deteriorating medical inpatients.


Acute medical unit; intensive care unit; early warning score system; Saudi Arabia.

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