Early-Warning Score Systems Supervised by Nurses and Their Impact on Quality of Healthcare
Keywords:
Early warning score, nursing supervision, patient safety, clinical deterioration, hospital mortality, rapid response.Abstract
Background:
Early-warning score (EWS) systems are designed to identify patient deterioration before critical events occur. When supervised by nurses, these systems may improve response time and outcomes, yet variability in implementation and effectiveness remains a concern. This review aimed to evaluate the impact of nurse-supervised EWS systems on healthcare quality outcomes.
Methods:
A systematic search was conducted in PubMed for studies published up to February 2025. Eligible studies included clinical trials and cohort designs evaluating EWS interventions supervised by nurses in hospital settings. Screening, data extraction, and risk of bias assessment were performed independently by two reviewers. Outcomes included mortality, cardiac arrest, ICU transfers, protocol compliance, and hospital stay.
Results:
Ten studies met inclusion criteria, comprising six cohorts and four trials from various regions including Saudi Arabia, Europe, and Asia. Electronic and manual EWS interventions led by nurses were associated with reduced in-hospital mortality (up to 1.3% absolute reduction), lower code blue events (relative reductions up to 85%), and improved protocol adherence (increased from 2.5% to 45.5%). ICU transfer and length of stay effects varied. Studies with combined digital platforms and escalation training showed the strongest results.
Conclusions:
Nurse-supervised EWS systems significantly enhance patient safety and clinical outcomes when implemented with structured escalation pathways and digital tools.
