Abstract Introduction Early identification of clinical deterioration in hospitalized patients is critical to improving outcomes and reducing unplanned rapid response team (RRT) activations and intensive care unit (ICU) transfers. Early Warning Scores (EWS) offer a standardized, objective tool to detect subtle physiological changes and prompt timely interventions. Although widely studied in academic centers, evidence on EWS effectiveness and implementation barriers in community hospitals remains limited. Methods In April 2025, a multidisciplinary task force introduced an EWS protocol across all medical inpatient units at a community hospital. Nursing staff recorded vital signs within the EWS framework, which automatically generated alerts in the EPIC electronic health record when pre-set criteria were met. These alerts prompted a physician for bedside evaluation, with subsequent management or transfer to higher levels of care as indicated. Over one month, initial data was collected on the number of EWS triggers, activations, subsequent ICU transfers, deaths, and declined (nurse perceived as not requiring action) activations. Results A total of 512 EWS triggers occurred in 194 unique patients during the study period. Of these, 86 triggers were activated (426 were deemed inappropriate by nursing staff). Among activated triggers, two resulted in RRTs and four led to ICU transfers. These numbers were comparable to pre-implementation rates of ICU transfers and RRTs. Documentation of EWS-related evaluations and communication between nurses and physicians was inconsistent, and many staff were unaware of the expected response time frames (e.g., physician call within 10 minutes, bedside evaluation within 30 minutes, documentation within one hour). Discussion Although this quality improvement project is ongoing and expected to have final results by April 2026, preliminary findings highlight key barriers to effective EWS utilization, including unclear response roles, incomplete documentation, and inconsistent communication. Planned interventions include targeted education sessions, joint physician-nursing meetings, and qualitative assessments to ensure shared understanding and streamline workflows. Monthly data will be collected alongside implementing key interventions until April 2026 to determine the impact of these improvements on RRT calls, ICU admissions, and in-hospital mortality. Conclusions EWS implementation in a community hospital setting has the potential to enhance early recognition of patient deterioration and reduce escalation to critical care. Success will depend on improving staff education, communication, and adherence to standardized response protocols. This abstract is funded by: none
Ashok et al. (Fri,) studied this question.