Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2022


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Karen Kesten, DNP APRN CCNS CNE FAAN; Dr. Ann Keane, PhD RN NEA- BC FACHE


Early Warning Score System; patient outcomes


Background: Hospitalized patients are at inherent risk of complications and further clinical deterioration, even in the presence of advanced medical interventions and expert caregivers, with the most significant risk being failure to rescue. Early Warning Score (EWS) systems allow for earlier, more effective identification of clinical deterioration than traditional medical emergency team (MET) systems and provide an opportunity to reduce failure to rescue events and improve patient outcomes.

Objective: The purpose of this quality improvement project was to implement an EWS system that allowed bedside caregivers to improve patient outcomes through reduction of failure to rescue events and improvement of patient outcomes.

Methods: The EWS assessment was embedded into the EHR in collaboration with Information Technology (IT). Staff was educated on routine EWS assessment and the structured response algorithm. Data was collected to examine the effects of the addition of an EWS system to the traditional MET structure on failure to rescue events and patient outcomes on adult inpatients on medical, surgical, and intermediate care units.

Results: 547 patients were included in the project sample, 277 received the EWS system. Improvement in patient outcomes was observed through a decrease in Code Blue events (2.8%), unplanned transfers to ICU (6.2%), ICU LOS (17.5%), total LOS (17.6%), mortality (0.7%), and failure-to-rescue events (12.9%) for patients receiving the EWS system in addition to the traditional MET structure. There was a statistically significant relationship between EWS system implementation and reduction in failure to rescue events (p<.05).

Conclusion: These results validate prior findings of the impact of EWS on failure to rescue events and patient outcomes. Improvement in patient outcomes were observed despite a significant COVID-19 surge during the post-implementation period, further supporting the benefits of the EWS system. The healthcare organization plans to sustain this practice through further EHR-integration on all adult inpatient medical, surgical, and intermediate care units.

Open Access


Available for download on Friday, September 15, 2023

Included in

Nursing Commons