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Comparison of general medical and general surgical nursing intervention following Early Warning Score triggers


The Early Warning Score (EWS) [1] has been delivered within the trust for 2 years. In our institution, the EWS protocol has been modified to allow a nurse intervention when EWS = 3 (Appendix 1). The aim of the study was to look at the efficacy of nursing interventions in medical and surgical patient groups.


Data were prospectively collected within the surgical and medical wards over a period of 10 weeks. We recorded information for any patient who triggered EWS ≥ 3. The person performing the first intervention and the prevention of further triggers was noted.


Nurses caring for acutely unwell medical patients were able to intervene in 60% of initial triggers without having to call for a doctor (Table 1). These interventions successfully reduced the score in 60% of cases. By contrast, in the surgical group, 16% of triggers were initially dealt with by the nursing staff, and these interventions were successful in 60% of cases.

Table 1
Appendix 1 Early Warning Score used in Central Manchester and Manchester Children's University NHS Trust


A number of factors could explain these differences: the intensive education package that accompanied the introduction of the score into medicine, differences within the patient groups, and the use of medical ward nurses assisting in the implementation of the score into their areas. Nursing intervention appears effective as first-line treatment for a trigger in many medical patients and we believe it is a useful part of the EWS protocol.


  1. Morgan RJM, Williams F, Wright MM: An early warning scoring system for detecting developing critical illness [abstract]. Clin Int Care 1997, 8: 100.

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Ingleby, S., Conway, D. Comparison of general medical and general surgical nursing intervention following Early Warning Score triggers. Crit Care 7 (Suppl 2), P237 (2003).

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