• Richard Pullinger, Sarah Wilson, Rob Way, Mauro Santos, David Wong, David Clifton, Jacqueline Birks, and Lionel Tarassenko.
• aEmergency Department, John Radcliffe Hospital bDepartment of Engineering Science, Institute of Biomedical Engineering cCentre for Statistics in Medicine, Botnar Research Centre, Oxford University, Oxford dEmergency Department, Wexham Park Hospital, Slough, UK.
• Eur J Emerg Med. 2017 Dec 1; 24 (6): e11-e16.

BackgroundUse of automated systems to aid identification of patient deterioration in routine hospital practice is limited and their impact on patient outcomes remains unclear. This study was designed to evaluate the feasibility of implementing an electronic observation chart with automated early warning score (EWS) calculation in the high-acuity area of an emergency department.MethodsThis study enrolled 3219 participants before and 3352 after implementation of an automated system, using bedside vital-sign entry on networked mobile devices. The primary outcome measure was the percentage of participants for whom an EWS was accurately recorded at each stage.ResultsOf the participants, 52.7% before and 92.9% after implementation of the electronic system had an accurate EWS recorded on charts available to the study team. Participant groups were well balanced for baseline characteristics and acuity.ConclusionIn this study, the feasibility and limitations of implementing an electronic observation chart in the ED were demonstrated. Accurate EWS documentation was more frequent after implementation of the electronic observation chart. Retrospective analysis suggests that the use of an electronic observation system may lead to a greater percentage of observations being taken from those patients with a higher EWS.

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