Association Between the National Early Warning Score and Nursing Workload in Acute Hospital Wards: A Multicentre Observational Study.

AIM: To evaluate whether the National Early Warning Score is associated with patient-level nursing care demand in acute hospital wards.

DESIGN

Multicentre observational study with prospective 24-h patient-level recording.

METHODS

Adult patients admitted to 10 acute care wards across five hospitals in the Autonomous Province of Bolzano were enrolled on predefined study days. The unit of analysis was the individual patient observed over 24 h. Nursing activities and time spent were recorded in real time using a structured form. Nursing care demand was measured as nursing care time, number of nursing activities, and patient-level workload overload, defined as care time above the seventy-fifth percentile.

RESULTS

A total of 392 patients were included. Median nursing care time increased from 139 min in patients scoring 0-4 to 184 min in those scoring 5-6 and 246 min in those scoring 7 or higher. The median number of nursing activities increased from 24 to 27 and 36. In adjusted analyses, higher National Early Warning Score values remained associated with greater nursing care time, more activities, and higher likelihood of patient-level workload overload.

CONCLUSION

The National Early Warning Score was associated with patient-level nursing care demand across heterogeneous acute hospital wards.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Routinely available acuity information may help nurses and managers identify patients requiring greater care time and support responsive workload assessment.

IMPACT: This study addresses the need for pragmatic indicators of nursing care demand in acute wards. Findings may inform patient assignment, workload monitoring, and clinical nursing practice.

REPORTING METHOD: The study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology statement.

NO PATIENT OR PUBLIC CONTRIBUTION: Patients and the public were not involved.