Assessment and early warning signs of deterioration in hospitalized patients


  • Badriah Y. Qawfashi Primary Health Care, Ministry of Health, Abu Arish, Saudi Arabia
  • Layla S. Darraj Primary Health Care, Ministry of Health, Abu Arish, Saudi Arabia
  • Abeer M. Haltani Primary Health Care, Ministry of Health, Abu Arish, Saudi Arabia
  • Somaiah Y. Moaafa Primary Health Care, Ministry of Health, Abu Arish, Saudi Arabia
  • Khaled A. Alshahrani Department of Forensic Medicine, Ministry of Health, Riyadh, Saudi Arabia
  • Aeshah B. Masmali Primary Health Care, Ministry of Health, Abu Arish, Saudi Arabia
  • Samira S. Aljohani Department of Infection Control, King Fahad Hospital, Medina, Saudi Arabia
  • Naif A. Alhujili Department of Infection Control, King Fahad Hospital, Medina, Saudi Arabia
  • Bandar S. Alzahrani Department of Public Health, Al-Baha Primary Healthcare Centers, Albaha, Saudi Arabia
  • Refah F. Aloslub Home Care Department, Al Iman General Hospital, Riyadh, Saudi Arabia



Early warning signs, Hospitalized patients, Modified early warning score, Rapid response teams, Patient care management


Efficient assessment methods and early warning systems are crucial to prevent events like arrest, unexpected transfers to the intensive care unit (ICU) or even death. This in-depth review delves into the aspects of evaluating and handling early warning indicators of deterioration among patients admitted to hospitals. The primary emphasis lies in identifying any signs of decline by observing and tracking indicators, like heart rate, blood pressure, respiratory rate, body temperature and oxygen saturation. Standardized assessments like the modified early warning score (MEWS) play a role in assessing the seriousness of a patient’s condition while rapid response teams (RRTs) provide interdisciplinary interventions. Personalized care plans, customized medication management and the inclusion of support highlight an approach. Continuously reevaluating patients and providing education for healthcare professionals underscores the nature of patient care. Despite advancements in technology that enable real time monitoring challenges such as alarm fatigue and the need for consistent staff training persist. This review concludes that a comprehensive strategy combining expertise standardized assessments and technological support is vital for managing early warning signs of deterioration to ultimately enhance patient outcomes in hospital environments.


Vincent JL, Einav S, Pearse R, Jaber S, Kranke P, Overdyk FJ, et al. Improving detection of patient deterioration in the general hospital ward environment. Eur J Anaesthesiol. 2018;35(5):325-33.

Swami T, Shams A, Mittelstadt M, Guenther C, Tse T, Noor H, et al. Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths. BMJ Open Qual. 2023;12(2).

Sutherasan Y, Theerawit P, Suporn A, Nongnuch A, Phanachet P, Kositchaiwat C. The impact of introducing the early warning scoring system and protocol on clinical outcomes in tertiary referral university hospital. Ther Clin Risk Manag. 2018;14:2089-95.

Brekke IJ, Puntervoll LH, Pedersen PB, Kellett J, Brabrand M. The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLoS One. 2019;14(1):e0210875.

Kim HI, Park S. Sepsis: Early Recognition and Optimized Treatment. Tuberc Respir Dis (Seoul). 2019;82(1):6-14.

Fairchild KD, O'Shea TM. Heart rate characteristics: physiomarkers for detection of late-onset neonatal sepsis. Clin Perinatol. 2010;37(3):581-98.

Kruisselbrink R, Kwizera A, Crowther M, Fox-Robichaud A, O'Shea T, Nakibuuka J, et al. Modified Early Warning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study. PLoS One. 2016;11(3):e0151408.

Mathukia C, Fan W, Vadyak K, Biege C, Krishnamurthy M. Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital. J Comm Hosp Intern Med Perspect. 2015;5(2):26716.

van Galen LS, Struik PW, Driesen BE, Merten H, Ludikhuize J, van der Spoel JI, et al. Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions. PLoS One. 2016;11(8):e0161393.

Nascimento L, Bonfati LV, Freitas MB, Mendes Junior JJA, Siqueira HV, Stevan SL. Sensors and Systems for Physical Rehabilitation and Health Monitoring-A Review. Sensors (Basel). 2020;20(15).

Bowman S. Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health Inf Manag. 2013;10:1.

Kao DP, Trinkley KE, Lin CT. Heart Failure Management Innovation Enabled by Electronic Health Records. JACC Heart Fail. 2020;8(3):223-33.

Beane A, Wijesiriwardana W, Pell C, Dullewe NP, Sujeewa JA, Rathnayake RMD, et al. Recognising the deterioration of patients in acute care wards: a qualitative study. Wellcome Open Res. 2022;7:137.

Hall KK, Lim A, Gale B. The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review. J Patient Saf. 2020;16(1):S3-7.

Le Lagadec MD, Dwyer T, Browne M. Indicators of patient deterioration in poorly resourced private hospitals: Which vital sign to watch? A retrospective case–control study. Aust Crit Care. 2023;28.

Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370(17):1583-93.

Boland J, Boland E, Brooks D. Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone. Clin Med (Lond). 2013;13(2):149-51.

Karcz M, Papadakos PJ. Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther. 2013;49(4):21-9.

Walter EJ, Hanna-Jumma S, Carraretto M, Forni L. The pathophysiological basis and consequences of fever. Crit Care. 2016;20(1):200.

Mitchell OJL, Neefe S, Ginestra JC, Schweickert WD, Falk S, Weissman GE, et al. Association of Time to Rapid Response Team Activation With Patient Outcomes Using a Range of Physiologic Deterioration Thresholds. Crit Care Explor. 2022;4(11):e0786.

Romero-Brufau S, Gaines K, Nicolas CT, Johnson MG, Hickman J, Huddleston JM. The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours. JAMIA Open. 2019;2(4):465-70.

Wood KA, Ranji SR, Ide B, Dracup K. Rapid response systems in adult academic medical centers. Jt Comm J Qual Patient Saf. 2009;35(9):475-82.

Borrelli B. The Assessment, Monitoring, and Enhancement of Treatment Fidelity In Public Health Clinical Trials. J Public Health Dent. 2011;71(s1):S52-63.




How to Cite

Qawfashi, B. Y., Darraj, L. S., Haltani, A. M., Moaafa, S. Y., Alshahrani, K. A., Masmali, A. B., Aljohani, S. S., Alhujili, N. A., Alzahrani, B. S., & Aloslub, R. F. (2023). Assessment and early warning signs of deterioration in hospitalized patients. International Journal Of Community Medicine And Public Health, 11(1), 414–418.



Review Articles