AB103. SOH24AB_219. iNEWS V2 escalation policy: a prospective observational study in single tertiary hospital in Ireland

Background: Early warning score systems are a simple tool designed to track and assist in the early recognition of patient deterioration. In 2013, the Irish National Early Warning Score (iNEWS) Version 1 was designed and implemented in hospitals across Ireland to help healthcare professional assessment and recognition of patient deterioration. In 2020, a 2nd version of the guidance was published. In it, they recommended a tiered response model which included critical care staff at an iNEWS of 7 or greater, regardless of clinical condition of the patient. With intensive care units (ICUs) already being extremely short staffed and burnt out post coronavirus disease (COVID), this extra stress may be the tipping point for many intensive care physicians.

Methods: Our study looked at all patients who fit the criteria for the new referral to ICU (iNEWS ≥7) over a 1-week period vs. all patients who were referred to ICU in the same timeframe.

Results: Over the time-period, 32 separate patients had iNEWS ≥7. Of the 32 patients identified, only 1 was referred and admitted to ICU. Giving a conservative measure of 30 minutes to review each patient, this equated to 16 extra hours of work per week. In this same time period, 10 other patients were referred to the ICU.

Conclusions: Although the iNEWs score is a good early scoring system for deterioration, clinical judgement is needed for decisions for ICU referral/admission. Unwarranted referrals to ICU will add extra workload to already overworked staff and could be detrimental for the care of other critically unwell patients.

Keywords: Critical care; deterioration; escalation; intensive care; review