Implementation of Early Warning Scoring System (EWSS) to Improve ‘ICU without Walls’

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Sunaryo T


EWSS + ICU without walls


The development of the concept of ‘ICU without walls’, or intensive services that are not only provided in intensive rooms but also given in inpatient rooms / general wards . needs to be developed in overcoming the limitations of intensive care rooms
The aim of study was investigate the influence of the implementation of the Early Warning Scoring System (EWSS) on the improvement of ‘ICU without walls’.
The Quasi experiment with analytical descriptive design. This study identified changes in the level of deterioration conditions based on the Early Warning Scoring System (EWSS) before and after the actions of clinical responses were presented. In addition, this study identified the places of treatment involved before and after the implementation of the Early Warning Scoring System (EWSS) to see the improvement of ‘ICU without walls’.
The results showed that the decrease in the EWSS scores led to decrease in referrals to ICU care; it means that the patients could still be treated in the non-ICU wards. The percentage of patients treated in ICU decreased, from 82.88% to 26.5%, It means that the non-ICU wards were able to provide emergency treatments according to the algorithm of clinical response based on the EWSS scores. So, the implementation of the EWSS was able to reduce the number of ICU occupancy and length of ICU care (BOR and AvLOS of ICU) by optimizing the use of non-ICU wards in overcoming patients’ clinical emergencies. In other words, non-ICU wards are able to serve as ‘ICU without walls’ in caring for critical patients 

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