Background Patient safety is a key priority for hospitals, a public health problem, and a human rights issue. Acute patients usually exhibit warning signs before experiencing critical health problems. These signs are often not recognized, which increases patient risk. Early recognition of deteriorating patients may improve the quality of healthcare and prevent severe complications. This study aimed to implement an early warning scoring system (EWSS) in an acute medical ward at King Abdulaziz Medical City (KAMC), and assess the effects of EWSS on patient outcomes.

Methods The improvement project applied a FOCUS-PDSA model, by first identifying the problem and then implementing EWSS as an intervention. Physicians and nurses were educated about the EWSS application. Nurses were trained on how to measure, calculate, and take actions upon scores, and when to call physicians for emergency assistance when a patient score reached an abnormal value based on the EWSS actions. A pocket-sized version of the EWSS tool was distributed to staff as an announcement and motivation. The intervention was carried out in small PDSA cycles and repeated, which enabled potential errors to be tackled, ensured accuracy of nursing documentation, validated the EWSS tool, and refined the implementation process. To assess the intervention, a total of 296 patients were observed for 6 months (November to April) before and after implementing EWSS for changes in three main indicators: mortality rate, intensive care unit (ICU) transfers, and CCRT reviews. To assess perception and satisfaction, a cross-sectional survey was administered to a convenient sample of staff in day and night ward shifts. Data were collected daily during the study period, entered into an Excel file, then imported to SPSS for analysis.

Results After implementing EWSS, mortality rate (p>0.05), ICU transfers (p<0.05), and CCRT reviews (p>0.05) were reduced. Staff perception towards EWSS implementation was high; 86% indicated a good understanding of the purpose of the intervention, 71% stated that EWSS helped in recognition of patients before deterioration, and 50% perceived the intervention as successful and recommended its implementation in other areas of the hospital.

Conclusion The findings showed that EWSS implementation was promising and well-perceived by staff as an efficient management tool towards patient safety. Yet, there is an urgent need to automate EWSS before implementing it at a large scale to decrease workload, record duplication, and score calculation errors. More efforts need to be carried out in staff training, motivation, and support as they are key aspects towards success.