Implementation an early warning system in a stroke unit: A study to improvement of the quality of nursing care

Introduction: Early warning systems (EWS) are integrated systems used in the monitoring of vital signs during the follow-up of patients in general services. Thanks to these systems, physiological deteriorations in patients can be detected rapidly and early intervention can be made to the patient, and it is expected to prevent deterioration, reduce the need for intensive care, prevent the length of hospital stay and have a positive effect on dependency/survival. Purpose: This study was conducted to implement a vital monitoring system structured with the NEWS2 Scale in a stroke unit and to measure its effects on patient outcomes (length of hospital stay, transfer to intensive care, dependency and mortality). Method: In the study, which is an action research, the results of patients admitted to the unit before and after EWS were compared. The period when EWS was not applied in the unit was taken as the control group. 1239 patients who applied to the unit and met the inclusion/exclusion criteria were included in the study. Patient follow-up was carried out with the NEWS2 early warning system in the study, and the Modified Rankin Scale was used to evaluate the dependency/survival status of all groups before and after the system. The adaptation status of the employees in the unit to the new system was evaluated twice before and after EWS with an additional qualitative study. Results: There was no difference between the groups in terms of sociodemographics. It was observed that hypertension, hyperlipidemia, peripheral arterial disease, congestive heart failure and transient ischemic attack history, which are risk factors for stroke, were significantly more common in the patient group after EWS (p<0.05). It was found that the type of stroke experienced by the group after EWS was ischemic and the anterior circulation region of the brain was more affected (p<0.05). There was no significant difference between the two groups in the hypothesized hospitalization period, transfer to intensive care and dependency/survival status (p>0.05). In the qualitative study in which employee opinions were obtained, employees stated that the quality of patient follow-up increased, employee awareness was provided and multidisciplinary communication improved. Conclusion: Although the prognostic factors of the group after EWS were worse, it was found that the duration of hospitalization, admission to intensive care, and dependency/survival outcomes were not worse, the rate of transfer to intensive care did not decrease as expected, but deaths did not increase, and patient safety was ensured with planned transfers. It was determined that the EWS application, which was the main variable of the study, contributed to the quality processes of the unit.