Marjon Borgert

32 Chapter 2 Table 3. ‘Presence of delay’ between critical MEWS calculation and noti cation of physicians. Patients on protocolized wards (N = 90) Patients on control wards (N = 9) Relative Risk (95% CI) P -value c ‘Presence of delay’ a when a critical MEWS was: Registered by a nurse or was retrospectively calculated, % (n/N) b 49 (28/57) 50 (2/4) 0.98 (0.36 to 2.71) 0.97 Registered by a nurse, % (n/N) b 22 (15/69) 20 (1/5) 1.09 (0.18 to 6.64) 0.93 Retrospectively calculated, % (n/N) b 39 (22/57) 50 (2/4) 0.77 (0.28 to 2.17) 0.65 a ‘ Presence of delay’ is the time between a critical MEWS measurement and the noti cation of the physician. b The ‘presence of delay’could not be determined in case one of the following deviations from the RRS-protocol was found: 1) in case the critical MEWS calculated by the nurse and/or retrospectively calculated critical MEWS were absent, or; 2) one or both of these critical MEWS were present after primary noti cation of the physician, or; 3) the noti ed critical MEWS registered by the nurse turned out to be based upon a miscalculation. c Fisher’s exact test AE incidence, RRT activations and ICU admissions During the three-month study period 64 AE occurred of which 95% (61/64) were unplanned ICU admissions and 5% (3/64) cardiopulmonary arrests. In September the AE incidence on protocol wards was 13.4/1000 hospital admissions which reduced to 8.5/1000 in November (95% CI: -0.004 to 0.014). The AE incidence in the control arm also dropped in the same period from 9.1/1000 to 6.5/1000 (95% CI: -0.006 to 0.012) (Fig. 3). The total number of RRT activations in the protocolized arm (62/84) was signi cantly higher compared to the control arm (22/84) ( X 2 =8.79, df=1, P < 0.003). The number of RRT activations on protocolized wards increased from 11.8/1000 to 19.6/1000. The number of activations on control wards was unchanged with 8.0/1000 in September to 9.8/1000 in October and 6.5/1000 in November. The APACHE IV score of patients admitted to the ICU in both arms showed no statistically signi cant di erence. APACHE IV scores in protocolized and control wards in September were 64 (IQR 58-82) and 63 (IQR 54- 97) and in November 61, (IQR 47-83) and 73, (IQR 54-108). Following a RRT activation, patients from protocolized wards were taken less often to the ICU in November (26% (6/23)) compared to September (67%, (10/15)). On control wards a slight decrease was observed in November (50% (3/6)) versus September (57% (4/7)).