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The Introduction of an Integrated Early Warning Score Observation ChartA Picture Paints a Thousand Words

Fung, Kenneth MBBS, BSc; Khan, Farrukh MBBS, FRCSI, FRCS; Dawson, Joseph MBBS, MRCS, MD, FRCS

doi: 10.1097/PTS.0b013e3182948a39
Original Articles

Objectives Previous studies have demonstrated that abnormal physiological observations are often recorded on patients’ observation charts but not acted on, with ensuing negative consequences. To address this issue within our hospital, traditional charts with a graphic depiction of observations were replaced with new charts combining early warning scores (EWS) with numerically depicted observations. However, the replacement did not include a graphic display of observations in the form of trend graphs. The present study compared the speed and accuracy of data interpretation between the 2 charts.

Methods Six clinical scenarios (low-grade temperature, spiking temperature, tachypnea, Cushing’s response, hypovolaemic shock and normal observations) were identically depicted on old and new charts, creating 12 charts. One hundred health-care professionals were asked to study each of the charts, and the time taken to give a diagnosis was recorded. Time taken and accuracy of response were compared between the 2 charts.

Results The old chart was associated with faster responses in all of the scenarios, reaching statistical significance in 5 of the 6 scenarios (P < 0.0001). Additionally, the response was more accurate in all of the scenarios, reaching statistical significance in 3 of the 6 scenarios (P < 0.0001). Overall, response to the old chart was 1.6 times faster (P < 0.0001) and 15% more accurate (90% versus 75%, P < 0.0001) than the new chart.

Conclusions Graphic display of data is associated with faster and more accurate assimilation of information. Hence, charts combining EWS with graphic portrayal of observation trends may contribute to earlier recognition of sick patients.

From the Department of Surgery, Basildon and Thurrock University Hospitals NHS Foundation Trust, Nethermayne, Basildon, Essex, United Kingdom.

Correspondence: Joseph Dawson, MBBS, MRCS, MD, FRCS, Department of Surgery, Basildon University Hospital NHS Trust, Nethermayne, Basildon, Essex, SS16 5NL (e-mail:

The authors disclose no conflict of interest.

© 2014 by Lippincott Williams & Wilkins