THE EFFECT OF INTRODUCING ADULT KHOULA EARLY WARNING SYSTEM (KEWS) AS AN INSERVICE IMPROVEMENT STRATEGY IN KHOULA HOSPITAL

Abstract

Introduction & Aims: This article emphasis on the aim of Khoula Hospital- Muscat to implement and increase staff awareness about the importance of KEWS in early identification and timely management of survival rate of deteriorated patients admitted in general wards. As a result, this will reduce the number of transfer- in and readmission within 24-48 hrs cases to ICU, the Length of Stay (LOS) and the number of cardiac arrests that lead to death. Methodology: A pilot (Descriptive) study (Phase One) was conducted for a period of one month (between March to April 2016) among adult inpatients of Male Neuro Surgical ward and Female Orthopedic Unit- 1. After tools and charts (Adult KEWS Observation Chart, Adult KEWS Escalation of Care, Adult KEWS Key, Adult KEWS Guidelines and i-SBAR Verbal Communication Tools) reviewed and approved from hospital HODs, training of all the staff in both wards was ensured. Then, the observation charts were distributed to all admitted patients in daily bases. The observational charts were collected daily for maintaining the KEWS statistics. Data analysis were undertaken with descriptive and inferential statistics. After approval of phase 1,the system was run manually for other five wards in phase two and three. Then the charts and tools being computerized in al Shifa 3 Plus, allowing the system to be generalized for other five wards. Currently, the system covered in a total of 12 adult general wards. Results: There was a total of 2292 of deteriorated cases which were attended by PART in 2017 in comparison to only 217 cases in 2016.The total number of the Trans In cases to the ICU from the targeted wards (which are applicable to KEWS) was 86 cases in 2017, making overall percentage of the trans- in adult patients to ICU from targeted general wards by the end of 2017 as 3.75%, compared to 26% in 2016. In addition, the number of cardiac arrest reduced from 7 cases in 2016 to 0 in 2017.Conclusion: The key message from this project is the potential for the adult 'KEWS' to drive a step change of improvements in quality of care, patient safety and clinical outcomes for acutely ill patients in Khoula hospital by standardizing the assessment and scoring system.