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Can J Rural Med. 2019 Jul-Sep;24(3):83-91. doi: 10.4103/CJRM.CJRM_17_18.

Standardised early warning scores in rural interfacility transfers: A pilot study into their potential as a decision-making aid.

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Faculty of Medicine, Southern Medical Program, University of British Columbia, Okanagan campus, Kelowna, BC, Canada.
Research Department, Interior Health Authority, Kelowna, BC, Canada.
Patient Transport Services, Interior Health Authority, Kelowna, BC, Canada.
The Centre for Rural Health Research, Department of Family Practice, University of British Columbia Vancouver, BC, Canada.


in English, French


While 12.4% of British Columbians live rurally, only 2.0% of specialists practise rurally, making interfacility transport of high-acuity patients vital. Decision-making aids have been identified as a way to improve the interfacility transfer process. We conducted a pilot study to explore the potential of the Standardised Early Warning Score (SEWS) as a decision-making aid for staff at sending facilities.


SEWSs were calculated from a database of 418 transfers from sending facilities in rural, small and medium population centres to larger receiving facilities. The SEWSs were compared against one another over time using McNemar's and the Wilcoxon signed-ranks tests. The SEWSs were then tested for their association with six outcomes using Pearson's or Fisher's Chi-squared test and the Mann-Whitney U-test.


While at the sending facility, both the number of SEWSs that was four or greater and the average SEWS decreased over time (P < 0.001 for both). A first SEWS of four or greater was predictive of more intervention categories during transport (P = 0.047), an adverse event during transport (P = 0.004), an adverse event within 30 min of arrival at the receiving facility (P = 0.004) and death before discharge from the receiving facility (P = 0.043) but not deterioration during transport, or the length of stay at the receiving facility.


Overall, the performance of the SEWS in the context of rural interfacility transport suggests that the tool will have utility in supporting decision-making.


Early warning scores; Standardised Early Warning Score; interfacility transfer; interfacility transport; rural Standardised Early Warning Score

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