Outreach and early warning systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

There is insufficient evidence whether outreach and early warning systems reduce hospital deaths or ICU admissions.

A Cochrane review included 2 cluster-randomised control trials on the impact of critical care outreach services on hospital mortality rates: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group.

Comment: The quality of evidence is downgraded by inconsistency (by variability in results across studies) and by imprecise results (few patients and wide confidence intervals).

Ədəbiyyat

1. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 2007 Jul 18;(3):CD005529.