| Abstract [eng] |
The application of an early warning score in clinical practice might help to reduce the number of cardiac and respiratory arrests or sudden deaths in the hospital and unplanned transfers to the Intensive Care Unit by objectively assessing the condition of patients, and ensuring the identification of patients who need to change the tactics of care or treatment in time. The purpose of this clinical audit and literature review was to evaluate deteriorated patients, who were transferred from Vilnius University Hospital Santaros Clinics Thoracic Surgery Department to the Intensive Care Unit according to the early warning score, to analyze the management of monitoring frequency and treatment tactics before the transfer to the Intensive Care Unit and to compare the existing practice of Vilnius University Hospital Santaros Clinics with the recommendations. Other purposes of this work were to inform the medical staff about the early warning score, risk stratification, the use of the escalation protocol, and to conduct a literature review about the advantages and disadvantages, and challenges of implementing early warning scales in the clinical practice. The data was collected from January 1 st, 2023 to January 1 st, 2024. The study group consisted of 18 patients who were transferred to the Intensive Care Unit from the Thoracic Surgery Department due to worsening conditions. Patients were divided into low, medium, and high-risk groups according to the national early warning score transferred to the Intensive Care Unit and the 24 hours before transfer to the Intensive Care Unit. The results show that 61 percent of patients belong to the high-risk group, 11 percent – low, and 28 percent of all patients after the transfer to the Intensive Care Unit – medium risk group. Analyzing patients’ condition 24 hours before transfer to the Intensive Care Unit, 42 percent belonged to the very low-risk group, low-risk – 33 percent, and medium-risk – 8 percent of all patients. The median frequency of low-risk monitoring was 16 hours – 14 percent of patients met the recommended monitoring frequency. The median frequency of low-risk monitoring was 18 hours. Urgent response to changing treatment tactics 24 hours before transfer to the Intensive Care Unit required 8 percent, and immediate response within 8-12 hours – 17 percent of all patients. On January 8 th, 2024 was organized training for the medical staff of the Thoracic Surgery Department about the application of the early warning score and the escalation protocol. However, the use of the early warning scale was observed 52 percent of the total hospitalization duration after the training. To summarize, Vilnius University Hospital Santaros Clinics Thoracic Surgery Department patients should be observed more frequently, nursing or treatment tactics should be changed earlier, and anesthesiologist-intensivist consultation for transfer to the Intensive Care Unit also should be considered earlier compared with the recommendations. |
