The introduction of the Early Warning Score in the Emergency Department: A retrospective cohort study.

Background: The combined use of the Manchester Triage System (MTS) with the Early Warning Score (EWS) may be useful in ensuring both appropriate prioritisation and continued monitoring in the Emergency Department (ED) leading to early intervention for deteriorating patients thus improving patient outcomes especially in overcrowded EDs.
Purpose: Determine the effect of the EWS and MTS on accuracy of the MTS and ED waiting times.
Methods: A retrospective cohort chart review of all adult patients who presented to the ED in one large hospital in Ireland (n = 10,048) at three time points between 1st September 2015-30th September 2016; 3 months prior to EWS introduction, implementation month and 9 months post-implementation.
Results: Patients were significantly more likely to be categorised as an MTS category 2 (rather than 3-5) after the EWS was introduced (p < 0.001). Waiting times between triage and clinician review (p < 0.05) increased as did total time in the ED (p > 0.001). A similar finding was observed for patients with an MTS of 3-5.
Conclusion: Although positive in terms of patient outcomes, the effective and sustained combined use of the MTS and EWS requires increased bed capacity and experienced clinical staff to ensure that the ED journey time reduced rather than increased.
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