No need to change patient deterioration early warning score parameters

The Health Quality & Safety Commission's national patient deterioration programme says there is no need to change the New Zealand early warning score (NZEWS) parameters during the COVID-19 pandemic.

The programme’s clinical lead, Dr Alex Psirides, says a number of factors influenced the decision:

• The NZEWS is a validated tool for detecting physiological deterioration regardless of the underlying disease process. This is as true for viral pneumonia (coronavirus or any other seasonal virus) as it is for any other pathology.
• The NZEWS scores four vital signs that are known to be signs of the presence or progression of COVID-19 – temperature, respiratory rate, oxygen saturation and the need to administer supplemental oxygen.
• The experience in caring for limited numbers of these patients in both New Zealand hospital wards and intensive care is that the disease trajectory follows that described in the overseas literature.
• Most New Zealand inpatients do not currently have COVID-19 disease, leading to confusion if two different early warning score systems were in use side-by-side.
• Modifying a validated tool in the absence of large-scale datasets and based on anecdote is inadvisable.
• Changing an established national tool across all district health boards requires significant education resources. This would remove them from areas where they are currently focused on both COVID-19 planning and response.

Dr Psirides says the programme will continue to monitor both literature and expert opinion during the pandemic.

'We endorse the recommendations of the International Society of Rapid Response Systems for rapid response and outreach teams during the COVID-19 pandemic, which is available here.

'The Commission’s talkingCOVID webpages also has a number of resources to help clinicians navigate care planning and decision-making in an empathetic and person-centric way in the current changing environment.

'Now, more than ever, we believe it is essential the choices clinicians make regarding treatment options are in line with patients’ wishes. This will ensure the care we provide is both warranted and wanted.'

The patient deterioration programme’s tools for shared goals of care discussions and documentation are available here.