WO2015044859A1

WO2015044859A1 - A methodology for hospitalized patient monitoring and icu risk prediction with a physiologic based early warning system

Info

Publication number: WO2015044859A1
Application number: PCT/IB2014/064752
Authority: WO
Inventors: Erkan HASSAN
Original assignee: Koninklijke Philips N.V.
Priority date: 2013-09-27
Filing date: 2014-09-23
Publication date: 2015-04-02

Abstract

A patient monitoring system includes a controller configured to adjust an amount of clinical intervention of a patient, the controller programmed to receive patient data from a patient monitoring system, calculate an early warning score (EWS) from the patient data, determine a patient deterioration from the calculated EWS, and adjust the amount of clinical intervention based on the patient deterioration.

Description

A METHODOLOGY FOR HOSPITALIZED PATIENT MONITORING AND ICU RISK PREDICTION WITH A PHYSIOLOGIC BASED EARLY WARNING SYSTEM

The present application relates generally to patient monitoring. It finds particular application in conjunction with the combination of Early Warning Scoring (EWS) monitoring, deterioration detection, and triggered response to provide risk prediction and will be described with particular reference thereto. However, it is to be understood that it also finds application in other applications, and is not necessarily limited to the aforementioned application.

Patient deterioration is often preceded by a period of abnormal vital signs. Recently, the concept of a composite early warning scoring has emerged with the goal of identifying patients with impending acute deterioration. Increasingly, clinicians often manually assess the risk of patient deterioration using an abnormality scoring system, such as a EWS system. Abnormality scoring systems unify assessments of a plurality of vital signs into a unified unit system and combine the individual assessments so as to determine a score of the risk of a patient, which may lead to preventable adverse events like ICU admission or death. Typical EWS scoring systems consist of various individual components including heart rate, respiratory rate, systolic blood pressure and an assessment of level of consciousness, temperature, urine output, oxygen saturation and age. Different breakpoints are typically used by each EWS scoring system between scoring bands for the various physiologic components. For example, various EWS scoring systems assign 1 point for respiratory rates between 15-20; 20-21 ; 20-29; and 21-30 breaths per minute. In addition, most EWS scoring systems do not include extreme physiologic derangements at the higher score brackets.

EWS systems should also allow for increased monitoring, assessment and/or interventions to either avoid worsening critical illness or earlier transfer to higher acuity settings. Recently there has been growing interest in the use of EWS in U.S. hospitalized floor patients, despite the paucity of published data from U.S. patients. . For example, most EWS scoring systems obtain a score on admission, at the time a clinician is called to the bedside, or report one composite of multiple scores. Therefore, it was not known if patients follow a progressive pattern in EWS as they are admitted to the hospital ward, clinically deteriorate and require ICU admission. Further, typical EWS scoring system do not evaluate the trend of sequential EWS in the identification of clinical instability prior to the need for ICU admission. A need exists to develop a system of care to monitor patients, preferably electronically, automatically detect an event suggestive of deterioration and trigger an appropriate response via a EWS. Further, when continuous monitoring is not available, most EWS systems monitor the patient every 6 or every 12 hours. The 12 hour patient assessments being preferred by those concerned with increased work flow, staffing levels and cost considerations. However, data for this recommendation is missing at the current time. Whether continuous or intermittent monitoring is instituted, a need exists for an appropriate response which should occur and if the response at a specific score should vary based on the patient population has not been addressed.

Thus, an effective EWS system frequently captures and calculates the score, but is part of an overall program identifying what patients should be assessed more closely as well as any specific intervention(s) correlated with a calculated score. A need exists for a EWS system to monitor patients, preferably electronically, automatically detect an event suggestive of deterioration and trigger an appropriate response.

The present application provides a new and improved patient monitoring system and method which overcomes the above-referenced problems and others.

In accordance with one aspect, a patient monitoring system is provided. The system including a controller configured to adjust an amount of clinical intervention of a patient, the controller programmed to receive patient data from a patient monitoring system, calculate an early warning score (EWS) from the patient data, determine a patient deterioration from the calculated EWS, and adjust the amount of clinical intervention based on the patient deterioration.

In accordance with another aspect, a method for adjusting clinical intervention is provided. The method including receiving patient data from a patient monitoring system, calculating an early warning score (EWS) from the patient data, determining a patient deterioration from the calculated EWS, and adjusting the amount of clinical intervention based on the patient deterioration. One advantage resides in having the EWS score automatically calculated which avoids calculation errors, leads to more complete patient records, and reduces the time to compute MEWS manually.

Another advantage resides in the detection and identification of patient deterioration.

Another advantage resides in the triggered clinical response based on change in patient status.

Still further advantages of the present invention will be appreciated to those of ordinary skill in the art upon reading and understand the following detailed description.

The invention may take form in various components and arrangements of components, and in various steps and arrangements of steps. The drawings are only for purposes of illustrating the preferred embodiments and are not to be construed as limiting the invention.

FIGURE 1 is a block diagram of an IT infrastructure in accordance with the present application.

FIGURE 2 is a table illustrative of a EWS scoring system.

FIGURE 3 is a flowchart diagram of the operation of a patient monitoring system in accordance with the present application.

With reference to FIGURE 1, a block diagram illustrates one embodiment of an information technology (IT) infrastructure 10 of a medical institution, such as a hospital. The IT infrastructure 10 suitably includes one or more patient monitoring systems 12, a patient information system 14, one or more patient information display systems 16, a deterioration detection system 18, and the like, interconnected via a communications network 20. It is contemplated that the communications network 20 includes one or more of the Intranet, a local area network, a wide area network, a wireless network, a wired network, a cellular network, a data bus, and the like.

The patient monitoring systems 12 obtain physiological data for patients (not shown) cared for by the medical institution. The physiological data is obtained automatically indicative of measurements of physiological parameters (or vital signs) of the patients, such as systolic blood pressure (mmHg), heart rate (beats per minute), respiratory rate (breaths per minute), temperature (Celsius), oxygen saturation (percentage), and the like. Typically, each of the patient monitoring systems 12 is associated with, and obtains physiological data for, a single patient, but patient monitoring systems associated with multiple patients are contemplated. In some embodiments, it is contemplated that the patient monitoring systems 12 include patient worn monitors and/or beside monitors. The physiological data is typically obtained continuously or intermittently.

One or more sensors 22 suitably obtain the physiological data. However, it is also contemplated that the physiological data is obtained from other components of the IT infrastructure 10, such as lab equipment, components with user input devices, and so on. The sensors 22 measure physiological parameters of the patients and generate physiological data indicative thereof. In some embodiments, the sensors 22 include one or more electrocardiographic (ECG) electrodes, blood pressure sensors, Sp02 sensors, pulse sensors, thermometers, respiratory sensors, noninvasive blood pressure (NBP) sensors, and the like. Typically, the sensors 22 are disposed on the person of a patient and external to the patient monitoring systems 12. However, sensors local to the patient monitoring systems are contemplated. Where the sensors 22 are external, the physiological data can be obtained via a databus, such as a serial bus, a universal serial bus (USB), or the like; a body coupled network; a Bluetooth, a ZigBee, a wired or a wireless network; a medical body area network (MB AN); or the like. In some embodiments, the physiological data can further include manual assessments of physiological parameters of the patient and other data pertaining to physiological parameters that cannot be measured by one of the sensors, and/or manual measurements of physiological parameters, such as temperature, respiration rate, and so on input by clinicians.

In some embodiments, the patient monitoring systems 12 further obtain patient data for patients cared for by the medical institution. The patient information system 14, such as a central record medical database, stores patient data for the patients cared for by the medical institution. For example, the patient information system 14 stores electronic medical records for each of the patients within the medical institution. The patient data including the patient's name, age, physiological data and patient scores, such as an early warning score (EWS), and the like.

Once all of the mandatory physiological and patient data is entered, a EWS score is calculated by the patient monitoring system 12 and EWS recommendations are displayed. Specifically, a patient score assesses the current status of the patient (or, in extreme conditions, the risk of death of a patient) and is obtained through calculation using the physiological and patient data and a scoring table of physiological parameters. Suitably, the physiological and patient data includes data for each parameter of the scoring table. In some embodiments, the patient monitoring systems 12 facilitate the generation of a patient score. For example, it is contemplated that a process in a processor-based controller 28 of the patient monitoring systems 12 automatically calculates a patient score based on obtained physiological data and patient data and a scoring table. As another example, it is contemplated that the patient monitoring systems 12 merely provide a clinician with the scoring table and/or the physiological and patient data, thereby leaving it to the clinician to calculate the patient score and input it into the relevant patient monitoring system via the user input devices 26. It should also be appreciated that the patient monitoring system 12 calculates the EWS at a minimum standard of every 12 hours. However, the frequency of the calculation of the EWS can be increased or decreased based on the level of care needed for each patient. For example, the EWS may be calculated every 8 hours for a patient with a higher required level of care. Further, it is also contemplated that the EWS of a patient requiring the highest level of care be calculated on a continuous basis. It should also be contemplated that the frequency of calculation of the EWS can be manually set by a clinician or performed on a spot-check basis.

The scoring table is suitably obtained from a remote component of the IT infrastructure 10, such as the patient information system 14, the patient information display systems 16, or the deterioration detection system 18, via the communications network 20. However, it also is contemplated the scoring table is obtained from one or more memories 30 of the patient monitoring systems 12 and/or selected and/or defined by a clinician via the user input devices 26.

With reference to FIGURE 2, an example of a scoring table for determining a patient EWS score is provided. The first column identifies parameters employed to calculate a patient score, and the first row identifies a sub-score to attribute to measured values of the parameters. Each of the cells, other than the cells of the first row and the first column, is associated with the parameter of its row of the cell and the sub-score of the column of the cell. Even more, each of the cells, other than the cells of the first row and the first column, includes a range of measured values for the parameter and sub-score associated with the cell. A sub-score for a measured value of a parameter is determined by matching the value to a cell in the row associated with the parameter and having a range matching the value. The patient EWS score is thus determined by summing the sub-scores of each of the measured values in the data, or using the worst case of the individual sub-scores or other rule definitions defined by the scoring schema.

Specifically, the EWS scoring table 100 includes a first column 102 identifying the parameters employed to calculate a patient score including systolic blood pressure (mmHg) 104, heart rate (beats per minute) 106, respiratory rate (breaths per minute) 108, temperature (Celsius) 110, age (years) 112, and oxygen saturation (percentage) 114. The scoring table 100 also includes a first row 118 that identifies a sub-score to attribute to measured values of the parameters. Each cell 120 is associated with the parameter of its row of the cell and the sub-score of the column of the cell. Further, each of the cells 120 includes a range of measured values for the parameter and sub-score associated with the cell 120. As shown, a systolic blood pressure less than 80 mmHg has an associated sub-score of 3; a systolic blood pressure between 80 mmHg and 94 mmHg has an associated sub-score of 2; a systolic blood pressure between 95 mmHg and 110 mmHg has an associated sub-score of 1 ; a systolic blood pressure between 111 mmHg and 179 mmHg has an associated sub-score of 0; a systolic blood pressure between 180 mmHg and 220 mmHg has an associated sub-score of 1 ; and a systolic blood pressure greater than 200 mmHg has an associated sub-score of 2. Likewise, a heart rate of less than 40 bpm has an associated sub-score of 3; a heart rate between 40 bpm and 49 bpm has an associated sub- score of 2; a heart rate between 50 bpm and 59 bpm has an associated sub-score of 1; a heart rate between 60 bpm and 100 bpm has an associated sub-score of 0; a heart rate between 101 bpm and 110 bpm has an associated sub-score of 1 ; a heart rate between 111 bpm and 129 bpm has an associated sub-score of 2; and a heart rate greater than 130 bpm has an associated sub-score of 3. A respiratory rate less than 6 bpm has an associated sub-score of 3; a respiratory rate between 6 bpm and 8 bpm has an associated sub-score of 2; a respiratory rate between 9 bpm and 10 bpm has an associated sub-score of 1; a respiratory rate between 11 bpm and 14 bpm has an associated sub-score of 0; a respiratory rate between 15 bpm and 20 bpm has an associated sub- score of 1 ; a respiratory rate between 21 bpm and 29 bpm has an associated sub-score of 2; and a respiratory rate greater than 30 bpm has an associated sub-score of 3. Likewise, a temperature less than 35 C has an associated sub-score of 2; a temperature between 35 C and 37.9 C has an associated sub-score of 0; a temperature between 38 C and 38.9 C has an associated sub-score of 1 ; a temperature between 39 C and 40 C has an associated sub-score of 2; and a temperature greater than 40 C has an associated sub-score of 3. Similarly, an age between 65 years and 74 years has an associated sub-score of 1 ; an age between 75 years and 84 years has an associated sub-score of 2; and an age greater than 85 years has an associated sub-score of 3. Likewise, an oxygen saturation less than 90 percent has an associated sub-score of 3; an oxygen saturation between 90 percent and 93 percent has an associated sub-score of 2; an oxygen saturation between 94 percent and 96 percent has an associated sub-score of 1 ; and an oxygen saturation between 97 percent and 100 percent has an associated sub-score of 0. As shown, each physiologic element was assigned a point value consistent with clinically relevant increases and decreases. Based on the value, each scoring component could receive four possible scores: 0 (normal range); 1 (slightly abnormal); 2 (moderately abnormal); 3 (severely abnormal). Each element was then summed together to derived the EWS as a whole number and could range from O to 18.

Referring back to FIGURE 1 , in addition to relaying patient data and/or physiological data, the patient monitoring systems 12 monitor the patients based on the received patient data and/or physiological data and/or update associated displays to graphically present the patient data and/or physiological data to clinicians. As to the former, when patient data and/or physiological data indicates a patient needs medical attention due to, for example, increasing and/or decreasing respiration rate or blood pressure, the patient monitoring systems 12 that received the patient data and/or physiological data typically generates audio and/or visuals alerts and/or messages notifying clinicians thereof. It is contemplated that message can be provided to the clinicians via the communications network 20. Along with displaying the physiological data, the controller 28 also displays the patient data such as the EWS scores. The controller 28 also displays the patient data such that the patient data is presented to indicate the patient state and deterioration to the clinician. Further, the patient monitoring system 12 also generates audio and/or displays visuals alerts and/or messages notifying clinicians of a need for possible clinical intervention and/or transfer to a higher level of care and will be described with further detail below.

To carry out the above noted functionality, the sensors 22 transmit the measured physiological data via a body coupled network, Bluetooth, wired or wireless network, or the like to a controller 28 of the patient monitoring systems 12. The patient monitoring systems 12 serves as a gathering point for the patient data and/or physiological data measured by sensors 22 and provides temporary storage for the data in a memory 30. The collected physiological data is concurrently transmitted to a controller 28 in the patient monitoring systems 12 which then transmit the physiological data through the communication network 20 to the patient information system 14 where the physiological data is displayed and stored. The controller 28 of the patient monitoring systems 12 also controls a display 24 to display the measured physiological data received from each of the sensors 22 in the corresponding patient monitoring system display 24.

The patient monitoring system 12 also includes an input device 22 that allows the user, such as a system administrator or clinician, to view, manipulate, and input patient data and physiological data displayed on the display 14. The input device 16 can be a separate component or integrated into the display 14 such as with a touch screen monitor. Where the patient monitoring systems 12 are operative to relay physiological data and patient data over the communications network 20, the patient monitoring systems 12 further include one or more communications units 32 facilitating communication between the controllers 28 and the communications network 20.

The deterioration detection system 18 receives past and current EWS scores from components of the IT infrastructure 10, such as the patient information system 14 and/or the patient monitoring systems 12, and/or one or more user input devices 54 of the deterioration detection system 18, and tracks the most recent patient status for each of the patients. A percentage of patients will clinically deteriorate regardless of monitoring; however, many will have preceding events. Detecting significant deterioration by the time a patient needs interventions or higher levels of care may not be the best approach. The deterioration detection system 18 includes predictive capabilities to correctly highlight those patients at risk of deterioration would be of greater value. The data generated from the EWS and the deterioration detection system 18 indicates routine monitoring identify patients with preceding events as early as 12 hours prior to the need of ICU admission. Based on this data, it appears most patients will have a EWS in the 0-2 range. If the score never deteriorates, one can be 95.7% confident the patient will not need higher level of care or interventions based on the negative predictive value.

For example, it has been found that patient's EWS significantly increased from 2.9 + 2.0 at 24 hours prior to ICU admission to 5.4 +2.6 at the time of ICU admission. Patients progressively worsened in EWS from 24 to 12 hours prior to ICU admission. In a similar fashion as the mean scores, patients transition from the 0-2 score at 24 hours prior to ICU admission to a 3-4 score 6 to 12 hours prior to admission, with a larger number of patients having a score 5 or greater at the time of ICU admission. Based on the clear pattern of worsening EWS from 24 hours prior to ICU admission, a patient with an EWS score of 0-2 most likely will not require higher levels of care. Patients with a score of 3 or 4 should be monitored more closely and frequently as they are at higher risk of requiring intervention. Patients with a score of 5 or above should have an immediate assessment by a physician for consideration of ICU admission.

As the EWS increases, so does the need for higher levels of care. A difference is observed between medical and surgical patients with a EWS of 2 points. Based on the EWS score, the deterioration detection system 18 provides clinician intervention or increased care of need based on the patient status. For example, if the initial EWS is 0-2 points in medical patients or 0-1 point in surgical patients, the EWS calculation is repeated on an every 12 hour frequency. If initial or any subsequent EWS is 3-4 in medical patients or 2-4 in surgical patients, the deterioration detection system 18 increases the frequency of clinical assessments of the patient for possible deterioration. If initial or any subsequent EWS is 5 points or higher, an immediate physician assessment of the patient is warranted for possible clinical intervention and/or transfer to a higher level of care. It should also be contemplated the frequency of the calculation of the EWS can be increased or decreased based on the EWS for each patient. For example, if the EWS score is 0-2 points, the frequency of calculation of the EWS occurs on a 12 hour frequency. If the EWS score is 3-4, the frequency of calculation of the EWS occurs on a 6 or 8 hour frequency. If the EWS score is 5 points or higher, the frequency of calculation of the EWS occurs on a 2 hour frequency or continuously.

Insofar as deterioration is detected, varying actions can be taken based upon the degree of difference between the scores. Actions include one or more of generating an audio and/or visual alert of patient deterioration in the patient monitoring systems 12 and/or the patient information system 14, logging the deterioration in a database, sending a message and/or page to a clinician via, for example, the communications network 20, and so on. In some embodiments, the patient deterioration system 108 further includes the user input devices 144 and/or the display 146 allowing a clinician to manually enter patient data and/or other parameters employed by the deterioration detection system 108. Optionally, the patient monitoring systems 12, the patient information system 14, and the patient information display system 16 include a deterioration detection unit which obtain the patient data and physiological data from the IT infrastructure 10 and detects patient deterioration.

The patient information display systems 16 receive patient data and/or physiological data for the patients including EWS scores cared for by the medical institution over the communications network 20 from a component of the IT infrastructure 10, such as the patient monitoring systems 12 and/or the patient information system 14. Typically, each of the patient information display systems 16 receives patient data and/or physiological data for a plurality of patients, but a patient information display system that receives patient and/or physiological data for a single patient is contemplated. Using the received data, the patient information display systems 16 monitor the patients and/or update associated displays 44 to display the physiological data and patient data to clinicians. As to the former, the patient data is displayed to indicate the patient state and deterioration to the clinician as described above.

In some embodiments, the patient information display systems 16 further allows clinicians to input patient data via one or more user input devices 46. It is contemplated that graphical user interfaces presented on the displays 44 can be employed to make it easier for the clinicians to enter the data. Upon inputting patient data, the patient data is suitably relayed to the patient information system 14 and/or other components of the IT infrastructure 10, such as the deterioration detection system 18, via the communications network 20. Additionally or alternatively, in some embodiments, the patient information display systems 16 include one or more of nursing stations, bedside monitors, mobile patient information displays, a deterioration detection station, a PDA, a tablet computer, a pager, and the like.

The patient monitoring system 12, patient information system 14, and patient information display system 16, and deterioration detection system 18 include at least one processor, for example a microprocessor or other software controlled device configured to execute patient monitoring software for performing the operations described in further detail below. Typically, the patient monitoring software is carried on tangible memory or a computer readable medium for execution by the processor. Types of non-transitory computer readable media include memory such as a hard disk drive, CD-ROM, DVD-ROM, internet servers, and the like. Other implementations of the processor are also contemplated. Display controllers, Application Specific Integrated Circuits (ASICs), FPGAs, and microcontrollers are illustrative examples of other types of component which may be implemented to provide functions of the processor. Embodiments may be implemented using software for execution by a processor, hardware, or some combination thereof.

FIGURE 11 illustrates a flowchart diagram of the operation of a patient monitoring system. In a step 200, patient data is received from a patient monitoring system. In a step 202, an EWS score is calculated from the patient data. In a step 204, the EWS is compared with preselected thresholds indicative of levels of deviation from normal. In a step 206, a patient deterioration is detected from comparing the EWS with the preselected thresholds. In a step 208, a frequency of calculation of EWS is changed based on the patient deterioration. In a step 210, a frequency of clinical or physician assessment is changed based on the patient deterioration. In a step 212, the patient level of care is changed based on the patient deterioration.

The invention has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be constructed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.

Claims

CLAIMS: Having thus described the preferred embodiments, the invention is now claimed to be:

1. A patient monitoring system comprising:

a controller configured to adjust an amount of clinical intervention of a patient, the controller programmed to:

receive patient data from a patient monitoring system;

calculate an early warning score (EWS) from the patient data;

determine a patient deterioration from the calculated EWS; and

adjust the amount of clinical intervention based on the patient deterioration.

2. The patient monitoring system according to claim 1 , wherein a EWS score is calculated from a plurality of patient sub-scores associated with the patient data.

3. The patient monitoring system according to claim 2, wherein the sub- scores are based on physiological parameters and a range of measured values for each parameter.

4. The patient monitoring system according to claim 3, wherein the physiological parameters include systolic blood pressure, heart rate, respiratory rate, temperature, age, and oxygen saturation.

5. The patient monitoring system according to claim 4, wherein the sub- scores include:

a systolic blood pressure:

less than 80 mmHg having an associated sub-score of 3;

between 80 mmHg and 94 mmHg having an associated sub-score of 2; between 95 mmHg and 110 mmHg having an associated sub-score of 1 ; between 111 mmHg and 179 mmHg having an associated sub-score of 0; between 180 mmHg and 220 mmHg having an associated sub-score of 1 ; greater than 200 mmHg having an associated sub-score of 2.

a heart rate:

of less than 40 bpm having an associated sub-score of 3;

between 40 bpm and 49 bpm having an associated sub-score of 2;

between 50 bpm and 59 bpm having an associated sub-score of 1 ;

between 60 bpm and 100 bpm having an associated sub-score of 0;

between 101 bpm and 110 bpm having an associated sub-score of 1 ; between 111 bpm and 129 bpm having an associated sub-score of 2; and greater than 130 bpm having an associated sub-score of 3;

a respiratory rate:

less than 6 bpm having an associated sub-score of 3;

between 6 bpm and 8 bpm having an associated sub-score of 2;

between 9 bpm and 10 bpm having an associated sub-score of 1 ;

between 11 bpm and 14 bpm having an associated sub-score of 0;

between 15 bpm and 20 bpm having an associated sub-score of 1 ;

between 21 bpm and 29 bpm having an associated sub-score of 2; and greater than 30 bpm having an associated sub-score of 3;

a temperature:

less than 35 C having an associated sub-score of 2

between 35 C and 37.9 C having an associated sub-score of 0;

between 38 C and 38.9 C having an associated sub-score of 1 ;

between 39 C and 40 C having an associated sub-score of 2; and greater than 40 C having an associated sub-score of 3;

an age:

between 65 years and 74 years having an associated sub-score of 1 ;

between 75 years and 84 years having an associated sub-score of 2; and greater than 85 years having an associated sub-score of 3; and

an oxygen saturation:

less than 90 percent having an associated sub-score of 3; between 90 percent and 93 percent having an associated sub-score of 2; between 94 percent and 96 percent having an associated sub-score of 1 ; between 97 percent and 100 percent having an associated sub-score of 0.

6. The patient monitoring system according to claim 1, wherein the deterioration of the patient is determined by comparing the EWS against predetermined thresholds.

7. The patient monitoring system according to claim 6, wherein the amount of clinical intervention include:

repeating the EWS calculation on an ever 12 hour frequency in response to the EWS being between 0-2 points;

increasing a frequency of clinical assessments in response to the EWS being between 3-4 points; and

immediate physician assessment and/or transfer to a higher level of care in response to the EWS being greater than 5 points.

8. A patient monitoring system, the system comprising:

the patient information system which receives and displays patient data; and one or more of the patient monitoring devices according to any one of claims 1-7.

9. A method for adjusting clinical intervention, the method comprising: receiving patient data from a patient monitoring system;

calculating an early warning score (EWS) from the patient data;

determining a patient deterioration from the calculated EWS; and adjusting the amount of clinical intervention based on the patient deterioration.

10. The method according to claim 9, wherein a EWS score is calculated from a plurality of patient sub-scores associated with the patient data.

11. The method according to claim 10, wherein the sub-scores are based on physiological parameters and a range of measured values for each parameter.

12. The method according to claim 11, wherein the physiological parameters include systolic blood pressure, heart rate, respiratory rate, temperature, age, and oxygen saturation.

13. The method according to claim 12, wherein the sub-scores include:

a systolic blood pressure:

less than 80 mmHg having an associated sub-score of 3;

between 80 mmHg and 94 mmHg having an associated sub-score of 2; between 95 mmHg and 110 mmHg having an associated sub-score of 1 ; between 111 mmHg and 179 mmHg having an associated sub-score of 0; between 180 mmHg and 220 mmHg having an associated sub-score of 1 ; and

greater than 200 mmHg having an associated sub-score of 2.

a heart rate:

of less than 40 bpm having an associated sub-score of 3;

between 40 bpm and 49 bpm having an associated sub-score of 2;

between 50 bpm and 59 bpm having an associated sub-score of 1 ;

between 60 bpm and 100 bpm having an associated sub-score of 0;

between 101 bpm and 110 bpm having an associated sub-score of 1; between 111 bpm and 129 bpm having an associated sub-score of 2; and greater than 130 bpm having an associated sub-score of 3;

a respiratory rate:

less than 6 bpm having an associated sub-score of 3;

between 6 bpm and 8 bpm having an associated sub-score of 2;

between 9 bpm and 10 bpm having an associated sub-score of 1 ;

between 11 bpm and 14 bpm having an associated sub-score of 0;

between 15 bpm and 20 bpm having an associated sub-score of 1 ;

between 21 bpm and 29 bpm having an associated sub-score of 2; and greater than 30 bpm having an associated sub-score of 3; a temperature:

less than 35 C having an associated sub-score of 2

between 35 C and 37.9 C having an associated sub-score of 0;

between 38 C and 38.9 C having an associated sub-score of 1 ;

an age:

between 65 years and 74 years having an associated sub-score of 1 ;

an oxygen saturation:

less than 90 percent having an associated sub-score of 3;

between 90 percent and 93 percent having an associated sub-score of 2; between 94 percent and 96 percent having an associated sub-score of 1 ; and

between 97 percent and 100 percent having an associated sub-score of 0.

14. The method according to claim 9, wherein the deterioration of the patient is determined by comparing the EWS against predetermined thresholds.

15. The method according to claim 14, wherein the amount of clinical intervention include: