The implementation of a national New Zealand Early Warning Score (NZEWS) would allow
a common language to be spoken across and within all facets of New Zealand healthcare.
Practical examples of this are given in Appendices C (a hypothetical patient flow diagram)
& D (an actual patient flow through Wellington Regional Hospital in October 2013 with
NZEWS calculated for each set of vital signs obtained).
Although the tool was developed to optimise the recognition of deteriorating acute hospital
in-patients, the NZEWS has value whenever a set of patient vital signs are obtained. Not
only is there benefit to the patient at the time of calculation of the NZEWS, but the change
in this score as the patient moves through the healthcare system may also have value.
The proven sensitivity and specificity of the NZEWS to predict deterioration1 may also
have value as a quality-of-care metric at an institutional level. For example, several
Australian authorities now request that Medical Emergency Team (MET) activation rates
(based on EWS systems) be reported as a quality metric.
A common language is only useful if the largest number of people speak it.
Within healthcare, this extends not only to pre-, intra- and inter-hospital settings but also to
the institutions involved in training the individuals that work within these areas. As such, it
covers the disparate array of environments where patients may meet healthcare
professionals, from GP surgeries to medical schools, from Intensive Care Units to
rehabilitation centres and nursing homes.
It is recognised that at present, a post-Babel state exists within current in-patient vital sign
scoring systems where no-one speaks the same language2. Each institution has
developed their own solution to the EWS problem with little evidence base. It is only
recently, with the availability of handheld computerised vital sign collection systems, that it
has been possible to collate datasets large enough for analysis for the sensitivity and
specificity of specific parameters in predicting deterioration