Intensive & critical care nursing · 2026
The use of the modified Dutch worry criteria, combined with vital signs and early warning scores, to improve nurses' recognition and escalation of ward deteriorating patients: A prospective cross-sectional observation multi-method study.
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Pirret Alison M, Ofori-Anyinam Kwadwo, De-Viell Sarah M, Goodin Kirsty, Turner Marlene
Аннотация
AIM: To determine if a modified nurse worry criteria, combined with vital signs and early warning scores: 1) improved nurses' ability to anticipate, recognise, prioritise, and escalate deteriorating patients and organise treatment and care; and 2) reduced the number of medical emergency team escalations.
METHODS: A prospective observational multi-method research design collected data using: 1) a questionnaire assessing the impact the modified nurse worry criteria had on nurses' response to patient deterioration, and 2) the critical care outreach data-base to determine a change in the number of medical emergency team escalations.
RESULTS: 121 nurses participated in the study with most agreeing or strongly agreeing the modified nurse worry criteria helped them anticipate (n = 111, 91.7%), recognise (n = 114, 94.2%), prioritise (n = 111, 91.7%); escalate (114, 94.2%) patient deterioration and organise treatment and care (n = 106, 87.6%). When compared to nurses with more or less experience, the modified nurse worry criteria improved organisation of treatment and care for nurses between two and five years nursing (p < 0.01), specialty (p = 0.03) and ward (p < 0.01) experience. No other significant differences were identified. Nurses reported more confidence in escalating to house officers (n = 90, 31.4%), charge nurse/senior nurse (n = 113, 93%), ward medical team at ward round (n = 47, 38.8%), critical care outreach (n = 71, 59.5%) and the medical emergency team (n = 30, 24.8%). Most wanted the modified worry criteria to continue in their wards (n = 114, 94.2%). No significant change in the number of medical emergency team escalations were identified (p = 0.56).
CONCLUSION: The modified nurse worry criteria helped nurses predict, respond to and manage deteriorating patients but did not change the number of medical emergency team escalations. The modified nurse worry criteria provided an added tool for nurses to enable earlier escalation of deteriorating patients.
IMPLICATIONS FOR CLINICAL PRACTICE: The modified nurse worry criteria provide nurses, firstly, with earlier signs of patient deterioration when early warning scores do not meet the escalation threshold, and secondly the language to justify and effectively escalate deteriorating patients.
METHODS: A prospective observational multi-method research design collected data using: 1) a questionnaire assessing the impact the modified nurse worry criteria had on nurses' response to patient deterioration, and 2) the critical care outreach data-base to determine a change in the number of medical emergency team escalations.
RESULTS: 121 nurses participated in the study with most agreeing or strongly agreeing the modified nurse worry criteria helped them anticipate (n = 111, 91.7%), recognise (n = 114, 94.2%), prioritise (n = 111, 91.7%); escalate (114, 94.2%) patient deterioration and organise treatment and care (n = 106, 87.6%). When compared to nurses with more or less experience, the modified nurse worry criteria improved organisation of treatment and care for nurses between two and five years nursing (p < 0.01), specialty (p = 0.03) and ward (p < 0.01) experience. No other significant differences were identified. Nurses reported more confidence in escalating to house officers (n = 90, 31.4%), charge nurse/senior nurse (n = 113, 93%), ward medical team at ward round (n = 47, 38.8%), critical care outreach (n = 71, 59.5%) and the medical emergency team (n = 30, 24.8%). Most wanted the modified worry criteria to continue in their wards (n = 114, 94.2%). No significant change in the number of medical emergency team escalations were identified (p = 0.56).
CONCLUSION: The modified nurse worry criteria helped nurses predict, respond to and manage deteriorating patients but did not change the number of medical emergency team escalations. The modified nurse worry criteria provided an added tool for nurses to enable earlier escalation of deteriorating patients.
IMPLICATIONS FOR CLINICAL PRACTICE: The modified nurse worry criteria provide nurses, firstly, with earlier signs of patient deterioration when early warning scores do not meet the escalation threshold, and secondly the language to justify and effectively escalate deteriorating patients.