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Nurses’ ‘worry’ as predictor of deteriorating surgical ward patients; a prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score

Nurses’ ‘worry’ as predictor of deteriorating surgical ward patients; a prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score
Nurses’ ‘worry’ as predictor of deteriorating surgical ward patients; a prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score
Background: Nurses’ ‘worry’ is used as a calling criterion in many Rapid Response Systems, however it is valued inconsistently. Furthermore, barriers to call the Rapid Response Team can cause delay in escalating care. The literature identifies nine indicators which trigger nurses to worry about a patient's condition.

Objectives: The objective of this study is to determine the significance of nurses’ ‘worry’ and/or indicators underlying ‘worry’ to predict unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality among surgical ward patients.

Design: a prospective cohort study.

Setting: a 500-bed tertiary University affiliated teaching hospital.

Participants: Adult, native speaking surgical patients, admitted to three surgical wards (traumatology, vascular- and abdominal/oncological surgery). We excluded patients with a non-ICU policy or with no curative treatment. Mentally incapacitated patients were also excluded

Methods: We developed a new clinical assessment tool, the Dutch-Early-Nurse-Worry-Indicator-Score (DENWIS) based on signs underlying ‘worry’. Nurses systematically scored their ‘worry’ and the DENWIS once per shift or at any moment of ‘worry’. DENWIS measurements were linked to routinely measured vital signs. The composite endpoint was unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality. The DENWIS-indicators were included in a univariate and multivariate logistic regression analysis, subsequently inserting ‘worry’ and the Early Warning Score into the model. We calculated the area under the receiver-operating characteristics curve.

Results: In 3,522 patients there were 102 (2.9%) patients with unplanned Intensive Care Unit/High Dependency Unit-admissions or unexpected mortality. ‘Worry’ (0.81) and the DENWIS-model (0.85) had a lower area under the receiver-operating characteristics curve than the Early Warning Score (0.86). Adding ‘worry’ and the Early Warning Score to the DENWIS-model resulted in higher areas under the receiver operating characteristics curves (0.87 and 0.91, respectively) compared with the Early Warning Score only based on vital signs.

Conclusions: In this single-center study we showed that adding the Early Warning Score based on vital signs to the DENWIS-indicators improves prediction of unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality.
0020-7489
1-30
Douw, Gooske
94b773e5-5b74-4cb0-997f-db7a010243d3
Huisman-de Waal, Getty
2ff64e2d-fa02-4e09-9aed-6e9140ebe3ef
van Zanten, Arthur R.H.
d73e8329-40a8-463b-b9c3-9529414fca22
van der Hoeven, Johannes G.
78ca86cf-76cd-4578-b063-649414423b43
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Douw, Gooske
94b773e5-5b74-4cb0-997f-db7a010243d3
Huisman-de Waal, Getty
2ff64e2d-fa02-4e09-9aed-6e9140ebe3ef
van Zanten, Arthur R.H.
d73e8329-40a8-463b-b9c3-9529414fca22
van der Hoeven, Johannes G.
78ca86cf-76cd-4578-b063-649414423b43
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de

Douw, Gooske, Huisman-de Waal, Getty, van Zanten, Arthur R.H., van der Hoeven, Johannes G. and Schoonhoven, Lisette (2016) Nurses’ ‘worry’ as predictor of deteriorating surgical ward patients; a prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score. International Journal of Nursing Studies, 1-30. (doi:10.1016/j.ijnurstu.2016.04.006).

Record type: Article

Abstract

Background: Nurses’ ‘worry’ is used as a calling criterion in many Rapid Response Systems, however it is valued inconsistently. Furthermore, barriers to call the Rapid Response Team can cause delay in escalating care. The literature identifies nine indicators which trigger nurses to worry about a patient's condition.

Objectives: The objective of this study is to determine the significance of nurses’ ‘worry’ and/or indicators underlying ‘worry’ to predict unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality among surgical ward patients.

Design: a prospective cohort study.

Setting: a 500-bed tertiary University affiliated teaching hospital.

Participants: Adult, native speaking surgical patients, admitted to three surgical wards (traumatology, vascular- and abdominal/oncological surgery). We excluded patients with a non-ICU policy or with no curative treatment. Mentally incapacitated patients were also excluded

Methods: We developed a new clinical assessment tool, the Dutch-Early-Nurse-Worry-Indicator-Score (DENWIS) based on signs underlying ‘worry’. Nurses systematically scored their ‘worry’ and the DENWIS once per shift or at any moment of ‘worry’. DENWIS measurements were linked to routinely measured vital signs. The composite endpoint was unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality. The DENWIS-indicators were included in a univariate and multivariate logistic regression analysis, subsequently inserting ‘worry’ and the Early Warning Score into the model. We calculated the area under the receiver-operating characteristics curve.

Results: In 3,522 patients there were 102 (2.9%) patients with unplanned Intensive Care Unit/High Dependency Unit-admissions or unexpected mortality. ‘Worry’ (0.81) and the DENWIS-model (0.85) had a lower area under the receiver-operating characteristics curve than the Early Warning Score (0.86). Adding ‘worry’ and the Early Warning Score to the DENWIS-model resulted in higher areas under the receiver operating characteristics curves (0.87 and 0.91, respectively) compared with the Early Warning Score only based on vital signs.

Conclusions: In this single-center study we showed that adding the Early Warning Score based on vital signs to the DENWIS-indicators improves prediction of unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality.

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Nurses’ ‘worry’ as predictor of deteriorating surgical ward patients - accepted.doc - Accepted Manuscript
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Accepted/In Press date: 5 April 2016
e-pub ahead of print date: 18 April 2016
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 393029
URI: http://eprints.soton.ac.uk/id/eprint/393029
ISSN: 0020-7489
PURE UUID: 38edfd4b-a9e1-40de-99f0-519753cf748b
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 20 Apr 2016 10:27
Last modified: 15 Mar 2024 05:30

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Contributors

Author: Gooske Douw
Author: Getty Huisman-de Waal
Author: Arthur R.H. van Zanten
Author: Johannes G. van der Hoeven

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