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All Journal International Journal of Public Health Excellence (IJPHE) Malahayati International Journal of Nursing and Health Science
Deviana, Elina
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Health Professions Medicine & Pharmacology Nursing Public Health

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A Systematic Review: Early Warning System for Hospital Wards Sasmito, Priyo; Aljufri, Salim; Mulyati, Leli; Rasmita, Dina; Syafridawita, Yetti; Deviana, Elina; Komariah, Elis; Gayatri, Sri Wahyuni; Arifani, Nisa
International Journal of Public Health Excellence (IJPHE) Vol. 3 No. 2 (2024): January-May
Publisher : PT Inovasi Pratama Internasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55299/ijphe.v3i2.782

Abstract

Most of the unexpected events occur in the hospital wards. An Early Warning System (EWS) is a system created to identify worsening patients outside the Intensive Care Unit (ICU). EWS is one of the requirements that must be met to get hospital accreditation. Hospitals have to choose the appropriate EWS to get optimal outcomes. This study aims to describe some of the EWS in the wards that have been researched and developed, as well as their performance in predicting severe adverse events (SAE). This study is a literature review design, conducting a systematic review by selecting relevant articles on Pub Med and Science Direct using the keyword "Early Warning Systems" in the 2018-2023 period. Out of 269 articles, only 12 articles that met the criteria. The selected articles are then systematically reviewed and analyzed. Based on the extraction results of 12 articles, 9 EWS were grouped into National Early Warning Score (NEWS) and its variants, Modified Early Warning Score (MEWS) and its variants, and EWS integrated with Electronic Medical Record (EMR). In choosing an EWS, hospitals must consider the complexity of the cases being managed and the capabilities of existing resources. The recommended EWS in hospital wards with limited resources is weighted EWS or EWS with combinations, such as NEWS and MEWS with variants. Meanwhile, hospitals that have used EMR can choose EWS integrated with EMR to increase their predictive value for SAE, as well as improve protocol compliance.
Sepsis protocol adherence and emergency department overcrowding: An observational study Arifani, Nisa; Mulyati, Leli; Sasmito, Priyo; Sujana, Treesia; Gayatri, Sri Wahyuni; Astuti, Novia Dwi; Librianty, Nurfanida; Lie, Sukirman; Deviana, Elina; Ihsan , Farly
Malahayati International Journal of Nursing and Health Science Vol. 8 No. 2 (2025): Volume 8 Number 2
Publisher : Program Studi Ilmu Keperawatan-fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/minh.v8i2.870

Abstract

Background: Emergency Department (ED) overcrowding is a persistent global challenge that affects the quality and timeliness of patient care, particularly for sepsis management. Despite established guidelines such as the hour-1 sepsis bundle and national sepsis guideline, adherence remains inconsistent. Purpose: To analyze the relationship between sepsis protocol compliance and emergency unit crowding. Method: A retrospective observational cohort study was conducted, analyzing adult sepsis and septic shock patients triaged as Priority 1. Data on patient demographics, sepsis severity scores, ED occupancy rates, and adherence to sepsis protocols using the Hour-1 sepsis bundle and the National Sepsis Guideline were collected. Statistical analysis was performed using Fisher’s Exact Test to examine associations between ED overcrowding and compliance with sepsis protocols, with a significance threshold of p<0.05. Results: This study included 38 cases with a mean age of 56.6 years and the majority (52.6%) of patients were female. Most cases were diagnosed with septic shock (55.3%) and the average occupancy rate of the emergency department was 80.8%. Serum lactate measurements were performed in 68.4% of cases, blood culture sampling in 21.1%, and broad-spectrum antibiotics were given in 94.7%. Full compliance with both sepsis protocols was only 5.3%. Compliance with fluid resuscitation was high at 97.4%, while compliance with blood culture sampling was low at 5.3% and 7.9%. No significant association was found between protocol compliance and ED crowding (p > 0.05). Conclusion: There was no significant correlation between ED crowding and adherence to sepsis protocols. Strategic and clinical policy interventions are needed to improve adherence to sepsis management guidelines. Suggestion: Future research should investigate additional barriers to sepsis care, such as financial constraints, physician decision-making processes, and variations in adherence across healthcare settings to develop more comprehensive strategies to improve sepsis outcomes worldwide.
Co-Authors Aljufri, Salim Arifani, Nisa Gayatri, Sri Wahyuni Ihsan , Farly Komariah, Elis Librianty, Nurfanida Lie, Sukirman Mulyati, Leli NOVIA DWI ASTUTI Rasmita, Dina Sasmito, Priyo Syafridawita, Yetti Treesia Sujana