domain of the CHEWS. Data from the patients' clinical
events during the pilot, bed assignment (higher dependency
bed or not), and the clinicians' assessments from the
interviews were documented.
The clinicians' assessments, patients' clinical events
during the pilot, bed assignment and the calculated
CHEWS scores were compared. There was consistent
agreement about patients' acuity among the clinicians'
assessments, bed assignments, and clinical events and these
were used to describe the patients' clinical presentations.
Nearly one-third (29.6%, n=8) of the patients had lower
CHEWS scores than the acuity severity of their clinical
presentation should have warranted (Figure 2). Of the
patients that scored too low, three patients were urgently
transferred to the CICU during the pilot, with one being
intubated upon arrival to the CICU. None of the three
patients' CHEWS scores were above a normal range and
therefore would not have triggered an escalation of care
response using the CHEWS tool.
An expert multidisciplinary panel from the CICU, ICU
and cardiac unit reviewed the patients' clinical presentations
and CHEWS scores. The following areas were identified as
sources for the score discrepancies:
• Behavior: “sleeping appropriately” was absent from
the CHEWS resulting in sleeping patients unnecessarily
scoring 1 point for this behavior.
• Cardiovascular: presence of arrhythmia was absent
from the CHEWS; heart rate range limits in the
CHEWS did not account for the wide age range of
patients, especially the newborns and infants.