Communication bundle uses early warning signs to improve care

The implementation of an early warning score communication bundle significantly decreased intensive care unit (ICU) admissions, according to a study published in the May 2018 issue of the American Journal of Critical Care. 

The unplanned admission of patients into the ICU is often caused by missing signs of clinical deterioration. In this study, researchers from Southern New Hampshire Medical Center examined the impact of an early warning score communication bundle on medical-surgical transfers to the ICU, rapid response team calls and morbidity of patients upon ICU transfer.

The hospital embedded the early warning system into the electronic medical record for patients in four medical-surgical units and the ICU. The system included a scale from 0 to 21, with scores above four receiving an exclamation point to notify staff. After the patient file was reviewed by ICU nurses, clinicians developed a care plan to address the patient’s needs. Data was collected three months prior to implementation and compared to results in the 18 months following implementation.


Results showed the communication bundle led to significant decreases in the unplanned transfer of medical-surgical patients to the ICU and ICU admissions of patients after a rapid response team call.

“The early-warning score helps identify patients with clinical signs of deterioration, but that information must be quickly communicated to a nurse with an appreciation for the urgency of the situation and the knowledge to take action,” said primary investigator Cheryl Gagne, RN, DNP, CNEA, chief nursing officer at the hospital. “Our communication bundle may have led to earlier and more effective interventions by medical-surgical nurses, facilitated by collaboration with experienced critical care nurses."